Public Bodies: Appointments
 - Question

Baroness Prosser: To ask Her Majesty’s Government what assessment they have made of whether recent appointments to public bodies have adhered to (1) the spirit and rules of the Governance Code on Public Appointments; and (2) relevant legislation, and of whether all such appointments have been made on merit.

Lord Young of Cookham: My Lords, the Governance Code on Public Appointments was introduced in January 2017. Ministers make appointments in accordance with the code as well as the relevant legislation. In addition, the Commissioner for Public Appointments provides independent assurance that the governance code is followed.

Baroness Prosser: I thank the Minister for that reply. However, despite his comments about the Commissioner for Public Appointments, in recent years there has been a reduction in the number of employee or trade union representatives appointed to public bodies, despite those people having demonstrated appropriate knowledge and experience. An employee representative was not appointed to the Institute for Apprenticeships, despite the history and recognition of the role that trade unions have played in developing the apprenticeships programme with the Government. TUC candidates have been sidelined from the ACAS council, the Industrial Injuries Advisory Council and the Social Security Advisory Committee. Do the Government fear the knowledge and experience that union reps will bring to the table? Are the Government not supportive of a partnership approach to developing our public services?

Lord Young of Cookham: I am grateful to the noble Baroness. Perhaps I may make a general point and then come to her specific question. If the Government are to make real progress in tackling some of the challenges that confront this country—low productivity, reskilling the workforce, getting underrepresented groups back into the labour market, driving up the quality of apprenticeships and reducing the gender pay gap—we will make faster progress if we have a positive and constructive relationship with those who represent the workforce; that is, the leaders the noble Baroness has just mentioned.
On the specific issue of appointments, until I spoke to the noble Baroness last night I had not appreciated that behind her Question was a concern about the perceived—in her mind—bias against trade union appointees to public bodies. I should like to make some inquiries on this. It is the case that Paul Nowak, deputy general-secretary of the TUC, was reappointed  to ACAS last year; Sally Hunt, the current president of the TUC, was reappointed to ACAS in November last year; Michael Hayes, who sits on the Unison national executive, was appointed to the HSE in November; and David Chrimes of the FDA was appointed to the Social Security Advisory Committee in October. However, I should like to do some more work on this and write to the noble Baroness.

Lord Robathan: My Lords, while the Minister is doing that work, could he also look into the political affiliations declared by people for public appointments? It has been said, although I have no idea if it is true, that the number of political affiliations declared in, say, the last 10 years are quite dramatically in favour of the Opposition rather than the government side.

Lord Young of Cookham: First, the number of appointees with declared political activity has fallen; it has halved since 2010, so there are fewer political appointees. Of those appointed in the last year for which I have statistics, we appointed more candidates who have declared affiliations to the Labour Party or the Liberal Democrats than those with affiliations to my party—something that may irritate someone sitting behind me.

Lord Dholakia: My Lords, last October the Prime Minister launched the race disparity audit following critical reports on race issues in the country. Will the Minister arrange the publication of ethnic breakdowns of appointments to public bodies, and do so on an annual basis, so that progress can be measured on equality of access and outcomes in public appointments?

Lord Young of Cookham: I am grateful to the noble Lord. He may be aware that we published a diversity commitment back in December with a declared target of increasing to 50% the number of public appointees who are women by 2022, and to 14% those from black and minority ethnic communities. At the moment, I think the figures are 43% and 10%, but if one looks at the most recent year for new appointments, 2016-17, the proportion of new appointments for women rose from 34% in 2013 to 49% last year. We will be publishing statistics regularly about the progress we are making to those declared targets for 2022.

Lord Bassam of Brighton: My Lords, in view of recent revelations, can the Minister explain to the House what specific account the Government take of historical social media output when considering public appointments?

Lord Young of Cookham: I welcome the noble Lord to the Back Benches, although it means that Ministers are now exposed to the forensic questions for which he is renowned. I believe he is referring to Toby Young. Perhaps I may make it clear that although Toby Young is the son of a life Peer, he is not the son of this one but of Michael Young, founder of the Consumers’ Association and the Open University: a good and great man, notwithstanding his support for the Labour Party.
On the serious issue that the noble Lord raises, the Commissioner for Public Appointments, whom I mentioned in my reply, is reviewing the Toby Young appointment and has already referred to the need for  due diligence about social media. We await his report with interest, and it may be that we need to revise the Governance Code on Public Appointments, which at the moment has a section on standards in public life and handling conflicts and includes something on the lines of potential embarrassments and so-called skeletons in the cupboard, before anything goes to Ministers. We are aware of the growing importance of social media in this respect.

Lord Morris of Aberavon: My Lords, will the Cabinet Office expand the pool from which appointments are made to limit the same people moving seamlessly from one quango to another when each quango obviously has different needs?

Lord Young of Cookham: I think that criticism is more relevant to some of the appointments of non-execs in the City than to public appointments, but I take on board the noble and learned Lord’s point. Each case is looked at on its merits against the background of the criteria, but if he is concerned that the same people are going round and round, I will certainly pass that on to the Cabinet Office to see whether we need to review the procedure.

Borderlands
 - Question

Lord Beith: To ask Her Majesty’s Government, further to the Chancellor’s speech on the Autumn Budget 2017, what progress has been made on a growth deal for the Borderlands.

Lord Bourne of Aberystwyth: My Lords, in the Budget, the Chancellor committed to opening negotiations for a growth deal with the borderlands following a proposal it submitted to the Government in September 2017. The Government, working closely with the Scottish Government, are now starting work with the borderlands to develop a deal that brings the private and public sectors together on both sides of the border to drive growth across the region.

Lord Beith: I am grateful to the Minister for his Answer, but can he clarify what would be available under this scheme for Berwick, which is on the English side of the border but is the economic and transport hub for the Scottish eastern borders? With two Governments, six or seven local authorities and a proposed “North of Tyne” elected mayor involved, who will make the decisions?

Lord Bourne of Aberystwyth: My Lords, five local authorities are involved in the borderlands area and have been discussing possibilities for some time, notwithstanding that the proposal was made in September last year. The first meetings since the Budget announcement were a week ago today: one in Carlisle—not, alas, in Berwick—and the other in Dumfries.  The Scottish Government, the UK Government, the local authorities and others were all represented. This will be driven by the area itself—it will bring forward proposals—rather than the Government. It is early stages yet, but to reassure the noble Lord, I can say that some of the proposals being looked at do involve Berwick—Berwick marina, a landing stage in Berwick for cruise ships, and the Berwick theatre—as well as various areas in Northumberland, such as the Kielder reservoir. There are also other developments across the area involving energy and tourism.

Lord Watts: My Lords, the three authorities on the north-east side of the border—Northumberland, North Tyneside and Newcastle—have secured something of a deal with the Government, who will supply £600 million to invest over 30 years, which is £20 million a year. Is that not bordering on the irrelevant, given the scale of the problems the area faces? I refer to my local government interests.

Lord Bourne of Aberystwyth: My Lords, obviously, the local authorities concerned, some of which are under the control of the noble Lord’s party, do not think so. They have come forward with proposals which we will be looking at, and there will be distinct advantages for the area. We are disappointed, obviously, that the southern side of the Tyne is not participating any more, but that is not on economic grounds. As the noble Lord well knows, it is on personal grounds.

Lord Watts: My Lords, given that the Government are now committed to regional plans involving the private and public sectors, does the Minister think it was wise to do away with the RDAs, which had a very successful record in many parts of this country?

Lord Bourne of Aberystwyth: My Lords, the noble Lord is right to draw attention to our many successful regional deals involving metro mayors, many of whom are operating very effectively across political parties, and to say that those are working well. The Government, as always, are focused on the future rather than the past. We are developing a very successful policy and I am glad that it has the noble Lord’s backing.

Lord Inglewood: My Lords, I declare an interest as a Cumbrian. Can my noble friend confirm that the money being talked about is new and not simply money that the local authorities in the area have anyway, and it is a question of robbing Peter to pay Paul?

Lord Bourne of Aberystwyth: My Lords, we do not know what the new money will be; it depends on the proposals made to the Chancellor, but in all likelihood there will be new money, just as there has been in other growth deals. Not all the money is from the public sector by any means; much of it will be driven by very successful businesses in the private sector.

Lord Purvis of Tweed: My Lords, the distance between the edge of my former constituency in the Scottish borders and the Eden district in Cumbria is the same as between London and Sheffield. A huge area is potentially covered by this issue, and each part  has distinct needs. That is why the local government committee in the Scottish Parliament has called for extra specificity in this deal, as opposed to city deals. As the Minister said, this has been on the table for quite a while—since I was in the Scottish Parliament—so can he give an assurance that agreement will be made in advance of the coming Budget, in time for the UK budget for English local authorities, and the Scottish Parliament budget process for the Scottish local authorities?

Lord Bourne of Aberystwyth: My Lords, the noble Lord is right about it being a very large area; it is also a very beautiful area that I had the privilege of travelling across fairly recently. He will appreciate that this is not solely within the control of the UK Government—or indeed, the Scottish Government, to be fair. It will be driven by what is happening on the ground with the businesses and local authorities that are now talking together. The early signs are that the meetings held last week were highly successful; everybody was full of praise for what was happening. There is a timescale to abide by, which means coming forward with concrete proposals no later than the late spring.

Baroness McIntosh of Pickering: My Lords, will my noble friend ensure that there is parity in all growth deals between rural and urban areas? Do the Government accept that it is infinitely more expensive to deliver public services in rural areas, which should be reflected in all such deals between public and private partners?

Lord Bourne of Aberystwyth: My Lords, I can understand my noble friend’s hyperbole, but I think “infinitely” more expensive might be slightly overdoing it. Nevertheless, she is absolutely right that this, like all growth deals, must benefit all parts of the area. This is a very rural area; there are issues on farming which are being pursued, as well as on sustainability, tourism and energy, which will benefit the whole region. That, I think, will be the essence of its success.

Lord Steel of Aikwood: Will the Minister welcome the fact that Carlisle airport has announced that it is going to resume scheduled services? That will help the whole region.

Lord Bourne of Aberystwyth: My Lords, I am grateful to the noble Lord. Yes, I certainly give an unqualified welcome to that. The noble Lord is absolutely right; it is very good news, which we have just heard publicly this week.

Lord Selkirk of Douglas: Is the Minister aware that there has been a great deal of dualling between Edinburgh and Berwick, but less dualling between Berwick and Newcastle? If this development can be encouraged, it will greatly help the local economies of Berwickshire and Northumberland.

Lord Bourne of Aberystwyth: My Lords, I thank my noble friend very much for that—I think the A1 is the dualling in question. The Government committed  £290 million to that in 2014, I think. My noble friend is absolutely right about the vital nature of infrastructure and good communications.

Lord Wallace of Saltaire: My Lords, it is very good to hear that progress is being made on the borderlands growth deal, but Yorkshire is a rather larger and more compact area. I was at a meeting in York last week with local councils, Peers and MPs for Yorkshire. We are now clear what we would like from the Government, but they seem very slow in responding to Yorkshire. Is there any progress in prospect on that?

Lord Bourne of Aberystwyth: My Lords, the noble Lord may be referring to the issue of the all-Yorkshire plan; I think that is what he is getting at. He will be aware that we are proceeding towards mayoral elections in the Sheffield City Region this year. There is the prospect after that, if the parties agree, of an all-Yorkshire deal down the line, as it were. But that is something for the area to come to the Government with proposals on. We have not had any concrete proposals, but if the area comes forward with some, we will of course look at them.

Lord Blunkett: My Lords, can the Minister confirm that there is a potential compromise—much welcomed, it has to be said—regarding going forward with the Sheffield City Region mayor? Would the Government consider weighing in and riding with that compromise?

Lord Bourne of Aberystwyth: My Lords, I know that the noble Lord takes a particular interest in this, for understandable reasons, from the Sheffield perspective. My right honourable friend the Secretary of State has written to the authorities in the Sheffield area outlining a compromise. I think that a response has come back and we are now looking at it. There is certainly a sign of some compromise emerging that will suit everybody in the Yorkshire region.

Brexit: Foreign Policy
 - Question

Lord Soley: To ask Her Majesty’s Government what assessment they have made of the foreign policy implications of the United Kingdom’s relationship with the European Union post-Brexit.

Lord Ahmad of Wimbledon: My Lords, as my right honourable friend the Prime Minister has said on a number of occasions, we remain committed to European security and values. Having reached sufficient progress on phase 1 of the negotiations, we will now begin work on the new, deep and special partnership. We will work with European partners to develop the details of an ambitious relationship, including on foreign policy, and alongside the negotiations we will be seeking even stronger bilateral relationships with member states.

Lord Soley: Currently, the high representative represents the European Union in its increasingly global activities, which are very important to this country. I have yet to hear any coherent plan from the Government on how we are going to relate to her work—at the moment there is an Italian high representative—and how we are going to balance that with our increasing representation in individual EU countries without stripping our assets from the rest of the world.

Lord Ahmad of Wimbledon: My Lords, as I have already said, the UK, after we leave the European Union, will remain committed to strengthening ties with the remaining members of the European Union. The noble Lord may well have seen the common foreign and security policy document that we published in September, which laid out some of the key areas of discussion. On his point about European partners, I am sure that he followed very closely the UK-French summit only last week. The issue of security on a bilateral basis, for example, among other areas, was discussed in a very deep way. That underlines the continuing sense of respect and importance that is given by European partners to the UK’s role after we leave the European Union.

Lord Howell of Guildford: My Lords, is not the implication of what my noble friend has said that, as we develop our deep and special relationship, we are going to need a great many more bilateral links with, obviously, the other 27 members of the European Union and the wider world? Does that not indicate that perhaps the time has come to put an end to trying to run large parts of our foreign policy on a shoestring?

Lord Ahmad of Wimbledon: My noble friend is right that it is important to look at this issue in broader terms. Of course, our European relationships are important, but I reiterate that we remain members of the Security Council, the G7, the G20 and, of course, NATO. My noble friend is right to raise the important point of resourcing. The Foreign Office budget—the core budget—will increase next year to £1.24 billion. My noble friend may also be pleased to hear that we are also looking to add support to the Foreign Office network within a European context.

Lord Hannay of Chiswick: My Lords, does the Minister recognise that last year we found ourselves in very close harmony with France, Germany and other European countries on a number of events, including climate change, Jerusalem and the Iran nuclear deal? Does he thinks that is pure happenstance or that there is a pattern there? By the way, does he think that we still control the bridge across the Atlantic between the United States and Europe, or is it controlled perhaps by President Macron?

Lord Ahmad of Wimbledon: Taking the noble Lord’s second question first, our relationship with the United States is important and strong. Indeed, the importance of NATO was reiterated and emphasised by my right honourable friend the Prime Minister during her meeting with the President in Washington. On the question of  how we will continue to work with our European partners on important issues such as climate change and the Iran nuclear deal, that meeting demonstrates that we are close to the United States but, because of our candid and strong relationship, we are able to have those conversations to ensure that, as we have seen both on climate change and the Iran deal, we can make strong representations to the US in a way that will, we hope, allow it to think again.

Baroness Northover: My Lords, does the Minister agree with all those who say that we have had a disproportionate influence on foreign policy within the EU? Does he also agree that European ambassadors, including ours, of course, work together in countries and before summits to maximise our influence further? What kind of arrangements and resources will the Government seek to make sure that this influence is not reduced further than it already is?

Lord Ahmad of Wimbledon: First, I disagree with the noble Baroness’s final point that the influence is decreasing. On the contrary, I have not found that when I have travelled across the world. For example, when I was in Ghana, we had various meetings with the EU representative as well as our high commissioner on the ground. The noble Baroness will know that the specifics are yet to be determined, but it is very clear to me and the Government that we will continue to have very strong ties with our European partners. Recent events such as the UK-French summit and the meeting in Poland demonstrated that other European partners take the same view.

Lord Collins of Highbury: My Lords, the key point is that our deep relationship and partnership has added value to collective action. The world faces its biggest refugee crisis, and leaving the EU will weaken our ability to act collectively. What are the Government doing to ensure that in the future, working with DfID and the ODA budget, we can act collectively in Europe to protect our security interests, not least the humanitarian concerns facing the world?

Lord Ahmad of Wimbledon: We are, I believe, one of only a few leading nations that fully manifest our commitment to our defence spending and our development spending, which I know all noble Lords support. On the noble Lord’s substantive point about how we will continue to work with our European partners on important issues which he raises such as the refugee crisis that we have seen on European borders, again, if he was to look at the detail of the recent summit with the French, he would see that these kinds of issues come to the fore and decisions are being taken. While, yes, we are leaving the European Union, we will look to work in a collaborative way with our European Union partners once we leave.

Lord Pearson of Rannoch: My Lords, would the Government agree that we built and released an empire and saved Europe from herself in two world wars without any assistance from Brussels? Is not any new EU army pretty well bound to be a dangerous failure, like the EU itself?

Lord Ahmad of Wimbledon: The United Kingdom is proud of its role during the two wars, and the alliances we built then with our European partners are important. On his question about an EU army, I believe there is no formal proposal on the table, and if there was and we were to remain a member of the EU, we would not support it. However, because we are leaving the EU, it will not be a relevant question for us.

Thirlmere Reservoir
 - Question

Lord Greaves: To ask Her Majesty’s Government, following objections by the Ministry of Defence, whether they intend to call in the planning application for zip wires across Thirlmere Reservoir.

Lord Greaves: My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and remind the House of my registered interest in outdoor activities.

Lord Bourne of Aberystwyth: My Lords, I think we are all intrigued by that. This application is currently under consideration by the Lake District National Park Authority. Noble Lords will appreciate that it would be inappropriate for me to comment on a current planning application. However, I can confirm that as this is within both a national park and a world heritage site, policies in the National Planning Policy Framework already give significant protection. The framework is a material consideration in any planning application.

Lord Greaves: My Lords, I will happily take the noble Lord rock climbing in the Lake District. Zip wires across Thirlmere are a very bad idea. They would be an inappropriate commercial intrusion into England’s premier national park, where fundamental policies include the conservation of the landscape together with recreational uses which are in harmony with that landscape, based firmly on the Sandford principles. Do the Government agree that their overriding responsibility, as the national Government in England, for this national park and nationally important natural heritage site—and indeed, as the Minister said, world heritage site—as the jewel in the English crown, means that they really ought to call in this application and stop it now?

Lord Bourne of Aberystwyth: My Lords, first of all, the Lake District is undoubtedly a jewel in the way that the noble Lord describes. However, I thought that there might be a Pendle dimension to this Question so, with a sort of macabre fascination, I googled “Lord Greaves Pendle zip wire” and found with alarm that there had indeed been a zip wire in Pendle until some 18 months ago. However, on the more serious issue, clearly we recognise, as I have indicated, that the national park is important. It was made a world heritage site relatively recently and became a national park longer ago. Both of those are factors that will be borne in mind with regard to the planning application, which I cannot comment on.

Lord Forsyth of Drumlean: Does my noble friend think that the protests from the Liberal Benches would be more realistic if they did not also take the view that our national parks should be covered in pylons and wind farms?

Lord Bourne of Aberystwyth: My Lords, I do not wish to enter into a dispute between my noble friend and the Benches opposite. I recognise that on occasion there is a question of consistency from the Liberal Democrat Benches. I can see that smiles are coming even from those Benches, so perhaps they recognise the validity of the comment.

Lord Clark of Windermere: My Lords, I declare an interest as chair of the world heritage site bid and as a resident of the Lake District National Park. Would the Minister accept and restate that, as he nominated the national park for world heritage site status, which is primarily about our cultural landscape and our natural beauty, it would be inappropriate for the tourist industry to see it as merely a way to create another Disneyland?

Lord Bourne of Aberystwyth: My Lords, the noble Lord speaks with great authority, and clearly I am very much in agreement about the particular beauty and characteristics of the Lake District. As I say, I am not in a position, as noble Lords will understand, to comment on a live application—which I think will be considered by the national park authority on 7 March.

Lord Cormack: My Lords—

Lord Alton of Liverpool: My Lords, in reflecting on what the noble Lords, Lord Greaves and Lord Clark, have just said to the House, will the Minister also reflect that the first battle for Thirlmere was the beginning of the conservation movement? It took place in the 1870s and was supported by John Ruskin and Thomas Carlyle, and what a disgrace it would be if in the 21st century we were to desecrate this most beautiful part of Britain.

Lord Bourne of Aberystwyth: My Lords, the noble Lord is right that it is important to see the historical context of these things, just as the Kinder Scout “trespass” was very significant in terms of national parks. I am sure that noble Lords will appreciate that there is a very important constitutional and legal principle here—that, as the Government, we are unable to comment on a live planning application. However, as I said, the nature of the Lake District and of world heritage sites means that particular protections will apply.

Lord Cormack: My Lords—

Lord Tebbit: My Lords—

Lord Cormack: I gave way last time.

Tebbit!

Lord Taylor of Holbeach: My Lords, I suggest that we hear from the noble Lord, Lord Tebbit.

Lord Tebbit: My Lords, does my noble friend not agree that, although the preservation of the natural beauty of this country should properly have a very high priority, the Government’s first obligation is to provide for the defence of this country, and that the proposed zip wire would be a highly dangerous impediment for our air crews when flying at low level?

Lord Bourne of Aberystwyth: My Lords, my noble friend speaks with great authority. I certainly agree about the importance of defence to the country. As I said, I cannot comment on the application, but the Ministry of Defence has already registered its objections and this matter will be considered by the planning authority.

Business of the House
 - Timing of Debates

Tabled by Baroness Evans of Bowes Park
That the debates on the Motions in the names of Lord McInnes of Kilwinning and Baroness Wheeler set down for today shall each be limited to 2½ hours.

Lord Taylor of Holbeach: My Lords, in the absence of my noble friend the Leader of the House, I beg to move the Motion standing in her name on the Order Paper.
Motion agreed.

Brexit: Devolved Administrations
 - Motion to Take Note

Moved by Lord McInnes of Kilwinning
That this House takes note of the role of the devolved Administrations in the process of withdrawal from the European Union and future opportunities for strengthening the union of the United Kingdom.

Lord McInnes of Kilwinning: My Lords, I am delighted to bring this important debate before your Lordships’ House this morning. I am especially pleased that so many noble Lords whose expertise goes far beyond mine have chosen to contribute. As I look through the speakers list, I see people from all parts of our United Kingdom, including a former Secretary of State, a former First Minister, a former Member of the Welsh Assembly, an Advocate-General and renowned legal and constitutional experts.
I hope that this debate will give my noble friend the Minister and the wider Government a feeling for the views of your Lordships’ House as we face the inevitable joys of the withdrawal Bill and, specifically, its implications for devolution and the union. I will endeavour to avoid an overdominance of Scotland in my remarks but inevitably, a little later, I may show too much interest in what I know best. However, I hope that that will be compensated for by noble Lords from other home nations.
Above all, and like many in this House, I increasingly find that my unionism drives and underpins my political opinions. Unsurprisingly, I voted no, successfully, in 2014 and Scotland remains part of the United Kingdom.  I was less successful in 2016, when the UK voted to leave the EU. My decision in 2016 to vote to remain in the EU was more than influenced, like that of many others in Scotland and Northern Ireland, by my fears for the impact on the union of a leave vote. Like many others, I was genuinely concerned that the fragility of Scotland’s place in the United Kingdom post the 2014 referendum and the Scottish nationalist sweep of Scotland in 2015 would be exacerbated by a leave vote in 2016. After all, an important part of the 2014 referendum had been a discussion of Scotland’s place in the EU and the fact that an independent Scotland would not enjoy automatic membership of the EU. I should have had more faith in my fellow Scots.
My concerns failed to understand one crucial factor, which was that even for those Scots who had voted to remain in the United Kingdom in 2014 and to remain in the EU in 2016, remaining part of the United Kingdom and avoiding another divisive independence referendum was of more importance. In underestimating this feeling I was not alone. The unionist commentariat in Scotland took a similar view. No less a figure than the author JK Rowling took to social media the day after the Brexit vote to say that Scotland would now seek independence. It is of little wonder, therefore, that Scotland’s First Minister also made the same misjudgment and began her campaign for a second independence referendum within hours of the declaration The inevitability of the end of the union seemed almost to be upon us. However, the Scottish people did not, thankfully, agree with that inevitability. The First Minister was punished for this at the general election last year. Unfortunately, she has not heeded that and only last week was once again threatening to make a decision on a second independence referendum by the end of this calendar year.
It is testament to the strength of the union that there has been broad public acceptance that Brexit is going ahead in Scotland and all the evidence is that there is now very little difference between Scottish public opinion and wider UK opinion on this issue. The question on the ballot referred to the whole UK leaving the EU and it will be the United Kingdom that leaves in its entirety.
While Scottish public opinion has over the past 18 months, if anything, become more unionist, it would be easy for complacency to descend as we go through the difficult constitutional time ahead. The union is made up of four component parts and it is in Northern Ireland that we have seen a real questioning of the union in the face of a potential hard border, which of course the Government have committed not to allow. This has been particularly true among younger unionist voters in Northern Ireland. In an opinion poll in November by the Belfast firm LucidTalk it was clear that, faced with the choice between remaining in the EU within a united Ireland or a so-called hard Brexit within the UK, the result would be too close to call as to whether Northern Ireland remained part of the United Kingdom.
The situation in Northern Ireland without a power-sharing Executive makes the interaction between the UK Government and the people’s political representatives and devolved feeling much more difficult. I ask the Minister: what success are the Government achieving  in including all political opinion in Northern Ireland in the process of proper engagement as we venture through the Brexit process?
As a unionist, I was pleased in December to hear my right honourable friend the Prime Minister commit to the intrinsic importance and centrality of Northern Ireland to our United Kingdom and that Brexit would not be allowed to undermine Northern Ireland’s place in the United Kingdom, while respecting the Good Friday agreement and the special requirements caused by the land border and the common travel area. The very public discussion of Northern Ireland’s place was, in retrospect, a good thing. All too often on the mainland, Northern Irish politics are given a cursory glance. It is important to recognise that we need to work across all four component parts to preserve the union as we move forward through Brexit.
As we are all aware, and as was debated in your Lordships’ House last October, we are fortunate to have had two thoughtful further reports from the Constitution Committee, on intergovernmental relations in 2015 and the union and devolution, and my noble friend Lord Boswell’s report from the EU Committee on Brexit and devolution. In that context, I very much look forward to the remarks of my noble friend Lord Lang. All these reports have pointed to the asymmetric nature of devolution and have placed before this House recommendations as to how the structures and processes should be improved. It is almost as if the juggernaut of Brexit and the constitutional upheaval coming down the line were foreseen. I hope the Minister will make this point in government. It is important that, as we leave the EU, we use that opportunity to implement the recommendations from these excellent reports from the Constitution Committee and the EU Committee.
Now is the time—over the next 15 months and through the transition or implementation period, depending on what you call it—when Brexit can give an opportunity to ensure that the intensity of the UK Government working closely with the Welsh, Scottish and, I hope, Northern Irish Administrations is used as a means to set in place processes and systems that normalise the present constitutional settlement. Every disagreement for the next 50 years cannot be allowed to become a constitutional crisis that destabilises the state and becomes an excuse for a Scottish or Welsh referendum or a border poll. The state must find a way to ensure that political disagreements between different Administrations can be absorbed in the workings and processes of good government.
The debate over Clause 11 of the withdrawal Bill in many ways offers a good example of how a mature and intense discussion can bring about agreement and consensus between the Governments, as well as Brexit creating more opportunity for framework agreements between the UK Government and the devolved Administrations. If we set aside the political rhetoric of the SNP about a power grab, it is clear that both the Welsh and Scottish Governments accept that the repatriation of powers in devolved areas cannot be allowed to undermine the single UK market, which is so important to all constituent parts of the UK, and that key policy areas require frameworks and joint working. At the same time, the UK Government recognise  that repatriated powers in devolved areas that require no framework should not be held here for the sake of it.
An opportunity will come before your Lordships’ House to amend Clause 11 of the withdrawal Bill and to ensure that joint agreement between the UK Government and the Scottish and Welsh Governments gives an underpinning to that agreement to allow the Brexit process to move forward in as consensual a way as possible. It is unfortunate that the wording of the amendment required could not be drafted and agreed by Her Majesty’s Government and the Welsh and Scottish Administrations while the Bill was still in the other place on Report, as had been anticipated. I am sure we will have a thoughtful debate when any such amendment comes before us.
The real lesson from this process has been the acceptance that a legislative consent Motion in the Welsh Assembly and the Scottish Parliament is important to Her Majesty’s Government and your Lordships’ House, even if it is not a legal necessity. I believe that represents a political maturity and understanding from Her Majesty’s Government and the devolved Administrations by not allowing themselves to enter too much of an entrenched position following political agendas.
Agreed frameworks of implementation and dispute resolution will also provide institutional normality that encourages working together and the kind of stability sought by each of the reports debated in this House. As Professor Nicola McEwen pointed out in her evidence to the Constitution Committee, regular interaction and interplay is a key pathfinder to a settled constitutional position. Since the Constitution Committee’s report on intergovernmental relations of 2015, the number of Joint Ministerial Committee meetings have increased in regularity and importance. There has also been the introduction of the joint ministerial council on European negotiations. Sometimes, these meetings have become an opportunity for an angry press statement outside but, overall, the interaction of the government machines in preparation for and implementation of such meetings can only be good for the union. They have also given the Welsh and Scottish Administrations further opportunity to work together, not always to Her Majesty’s Government’s comfort.
Likewise, the repatriation of powers from the EU can only help increase the joint working required between Whitehall departments and the devolved Administrations, which has been an increasing problem because of silo-isation over the past five to 10 years. I look forward to my noble friend the Minister giving us his impression of what Her Majesty’s Government propose to do to ensure that those departments continue to work with the devolved Administrations.
An increasing problem for the union has been a failure of understanding among the general population of which powers are reserved and which are devolved. This was raised specifically in the Constitution Committee’s report. Such a lack of understanding has been a consequence of changes and reports which have been constant through all three devolved Administrations during the past 20 years. Following the implementation of the Silk and Smith recommendations, Brexit gives  an opportunity for clarity to be established that demonstrates the diversity that devolution brings to the United Kingdom. For that reason, Her Majesty’s Government and the devolved Administrations cannot constantly be opposites, point-scoring against one another. Of course there will be political dispute—there has to be—but normalising devolution requires a focus on the expectations of the people affected by government. Outside England, that means accepting that people have two Governments, with agreed competencies and processes in place to ensure that disputes are dealt with properly.
While, like many Scots, I may not have been overly optimistic about the future of Scotland’s place in the United Kingdom in the early hours of 24 June 2016, I now hope to see Brexit used as a means and a catalyst for the normalisation and stabilisation of the constitutional settlement in our United Kingdom. The United Kingdom’s tradition of slow, organic change has been somewhat challenged by the past 20 years. With the extra catalyst of Brexit, we must now ensure strength and vitality for our union over the long term. I look forward to the input from many eminent noble Lords in this debate. I beg to move.

Lord McConnell of Glenscorrodale: My Lords, I congratulate the noble Lord, Lord McInnes, on securing this debate on Burns day, which seems particularly appropriate. I know that the debate will cover the whole United Kingdom and not just Scotland, but we celebrate this day with particular gusto. It is celebrated throughout the world, because Burns was an internationalist—he never travelled further than Newcastle, but he understood the rest of the world and was able to write about it in creative and passionate ways which would shame many of the debates that have taken place across Scotland and the UK during the past two years.
I congratulate the noble Lord also on his introductory speech. It was an incredibly thoughtful and reflective speech that indicates that he will make a significant contribution to your Lordships’ House. He may not, as he said, have the same level of political experience as some other speakers in this debate, but his contribution was outstanding and I welcome the opportunity to follow him.
I have been a lifelong supporter both of home rule for Scotland within the United Kingdom and of the United Kingdom’s membership of the European Union. I have watched with despair over recent years as in both referenda the campaigns promoting the position that I adopt failed to make a positive case and focused far too much on the negative—in one case just surviving and in the other just losing. However, despite that position, which I have held all my life, it is my very strong view that the role of your Lordships’ House over these coming weeks and months is not to overturn the result of the referendum in 2016 but to scrutinise the way in which the Government are implementing that referendum result and to try to help to shape the future of the United Kingdom in this new set of circumstances.
For the two decades between 1979 and 1999, a massive debate took place, not just in Scotland but elsewhere in the United Kingdom, about the future of the principle that there should be democratic accountability for Scottish domestic affairs in Scotland within the framework of the United Kingdom. Over the course of those two decades, the debates that took place produced a national consensus—ultimately, the consent for that national consensus was demonstrated in the referendum of 1997—and a scheme in legislation that, despite all the political ups and downs of the past 18 or 19 years, has actually stood the test of time legally, not least because of the contribution of my noble and learned friend Lord Irvine, who was one of the key figures in ensuring that we had a Bill and an Act for Scottish devolution that was intellectually rigorous and would stand the test of time.
In the approach that we take to these decisions post Brexit, we need to apply the same level of rigour and principle as was applied back in 1997, 1998 and 1999. In the two decades since 1999, we have seen too many piecemeal changes, not properly thought through—compromises established because of immediate political circumstances rather than based on the principles of the original settlement. We have also seen over that time, partly because of the political ups and downs but also because of a lack of understanding at the centre of the British state, an inability or unwillingness to reform how the UK Government operate, both in relation to the devolved Governments in Scotland, Wales and Northern Ireland but in relation to its own internal affairs following the huge reform that took place in the decentralisation of power in 1999.
Not only should we in this debate address the principles of the split between devolved and reserved responsibilities post Brexit, but we should also say something about the way in which Brexit, for all its faults and for all the worries that many of us may have about it, provides an opportunity to reinvigorate and refresh the way in which the UK is governed, both at the centre and in relation to the devolved Governments and devolved responsibilities.
First, on the principles, it seems blatantly obvious that the principle at the heart of the Government’s decisions, and, I hope, the legislation that finally passes through both Houses of this Parliament, has to be that the matters repatriated from the European Union should be devolved, unless it is absolutely essential that they are reserved in the national interest. It also seems to me blatantly obvious that, within those devolved responsibilities, there are areas that, of course, the Scottish, Welsh and Northern Irish Governments will get on with and operate autonomously, but there are other areas where there have to be common frameworks. In the same way as there have been common frameworks and indeed common laws across the European Union on issues such as agriculture, fisheries and the environment and so on, over the last 40 or 50 years, we also need to have those common frameworks and perhaps, occasionally, common laws across the United Kingdom. So devolved Governments need to commit, and commit firmly, to those common frameworks.
As I said previously, if we have this debate transparently and openly, we can reach that agreement. The egos and ideologies that are getting in the way of reaching  this agreement, in both the British Government and the Scottish Government and elsewhere, have got this fundamentally wrong. They need to get on with making an agreement and allowing us to move on to the next stage—and the next stage needs to include reforming the relationships and a new level of engagement, which could make a real difference to the UK post Brexit. First, the new partnership, sharing common frameworks across the UK that allow for common decision-making, voluntarily agreed by the devolved Governments but firmly agreed and implemented consistently across the UK, could be a new way of working inside the UK that would actually refresh both the UK and the method of government, including attention to detail in policy in Scotland in particular.
I also believe, however, that there is need for a new level of engagement from the Scottish Government and perhaps others in the work of the British Government at home and abroad. In the time of the noble Lord, Lord Kerr, at the Foreign Office, and his successor, the noble Lord, Lord Jay, the Scottish Government were actively involved with the Foreign Office in adding value to the work of the UK internationally, as well as representing Scottish interests. I think that has diminished over the past decade. I believe there is a real opportunity here—in international trade negotiations, representing the Scotch whisky industry, food and drink, oil and gas, in internal debates on immigration, in all these areas—for fresh engagement and a new, fresh voice for Scotland that I hope the Scottish Government will be willing to seize.

Lord Wallace of Tankerness: My Lords, I too congratulate the noble Lord, Lord McInnes of Kilwinning, on introducing this important debate. It is a great pleasure to follow the noble Lord, Lord McConnell of Glenscorrodale, with whom I worked co-operatively and productively in government in Scotland for six years.
I think I was one of those, along with the noble Lord, Lord McInnes, who believed in the union—indeed, I speak unashamedly as a member of the only party that unequivocally supports Scotland within a United Kingdom and a United Kingdom within the European Union—but I was one of those who felt fragile about Scotland in the union in the immediate aftermath of the 2016 referendum. Indeed, when the First Minister was putting forward the idea of a second referendum, which, as we all know, has subsequently produced a collective yawn, she found out that it was difficult to persuade some of her own supporters. A significant number of people who had supported independence also supported Brexit. I actually applaud the consistency of that position.
I also think that what we are now finding is that, almost certainly inadvertently, the Scottish Government are starting to make out some good arguments for Scotland remaining in the United Kingdom. Last week, they published a paper entitled Scotland’s Place in Europe: People, Jobs and Investment, which said that a failure to stay in the European Union single market or secure a free trade agreement would see Scotland’s GDP around £12.7 billion lower by 2030 than it would under continued EU membership. That amounts to a  loss equivalent to £2,300 per person per annum. Our experience of the somewhat fantasy figures produced by the Scottish Government in their White Paper in the run-up to the independence referendum should perhaps mean that we take these figures with some care, but the general impact will not be doubted.
But if that is the impact of leaving the single market, what greater impact would there be of leaving the single market of the United Kingdom, which has lasted for more than 300 years with a single currency and a common language? The SNP point to the fact that the European Union market is one of 500 million, but as Mr Kevin Hague of These Islands says in his blog this week,
“Of course the EU market is much larger, but even after nearly 45 years of unfettered market access our exports there are relatively small (16%) compared to those to the rest of the UK (63%)”.
So we may perhaps suggest that leaving the single market of the United Kingdom would have an impact four times as great.
The noble Lord, Lord McInnes, said we should not be complacent. Indeed, we cannot take our union for granted; it needs careful nurturing. That is particularly so at a time of constitutional upheaval. I agree with the noble Lord, Lord McConnell, who said that as we approach the European Union (Withdrawal) Bill we must apply to it the rigour with which the initial devolution settlement was approached in 1997-98. There will be plenty of opportunities over the next few weeks to look at that Bill in general and Clause 11 in particular.
I do not believe that this Government have done the union any favours by the cack-handed approach they have adopted to the Bill, particularly their treatment of the devolution settlement in Clause 11. As the conclusion of the first report of the Public Administration and Constitutional Affairs Committee in the other place said in November:
“The overall concerns regarding the devolution aspects of the EUW Bill arise from the constitutionally insensitive nature of the UK Government’s approach in Clause 11”.
It is not fit for purpose. It turns on its head the spirit of the devolution settlement: that everything is devolved except what is expressly reserved.
We now seem to have got some recognition from the Government that they got it wrong. The Secretary of State for Scotland promised amendments in the House of Commons. I will not indulge in scoring political points that they were not produced; I think it is better to get it right than rush it. However, it is a matter of regret that the elected House will not have a proper opportunity to consider the amendments—only in ping-pong.
I very much share the view expressed by the noble Lord, Lord McConnell, that getting an agreement should not be terribly difficult. In Scotland, there are an estimated 111 instances where powers being repatriated have a devolution component. The Scottish Government agree that there are areas—not least with regard to the functioning of the single market in the United Kingdom—where UK frameworks are necessary. The United Kingdom Government agree that some elements can be directly devolved to Belfast, Cardiff and Edinburgh on Brexit day plus one, but on others we will require memorandums of understanding, working  together and common agreements. Rather than political grandstanding, a bit of rolling up the sleeves and getting down to it would be very helpful.
I cannot accept that a Parliament such as this—which in the past two years devolved the whole of income tax, with one or two exceptions, to the Scottish Parliament—will find a stumbling block when it comes to issues such as chemical regulations, including pesticides, or energy performances and building directives. A good dose of common sense will sort this out. The Minister should tell the House, as we approach Second Reading, where the agreements are that have already been reached. Is it a complete stalemate, or are there areas where it has already been identified what goes into each basket, be it in terms of common frameworks, memorandums of understanding or direct devolution?
The European Union Committee, whose report, as the noble Lord, Lord McInnes, indicated, we debated in October, talked about the need to set aside differences and work constructively. That is particularly the case today. Looking to the future, we need that spirit of co-operation.
Last night, I attended a seminar by the Institute of Chartered Accountants of Scotland—I refer to my entry in the register of interests as chair of the regulation board—on what we can learn from Canada for Brexit. I learned that when CETA was being negotiated, representatives from the provinces and the territories were always in the negotiation room. I think the Government could do a lot better than they have been up to now in engaging and embracing active collaboration and co-operation from the devolved Administrations. Early on, I remember giving evidence to the Select Committee on the Constitution, where it was suggested, not only by me, that there was much merit in seconding civil servants from the Welsh and Scottish Governments into DExEU or the Cabinet Office to assist. I am not sure whether it ever happened; perhaps the Minister can tell us.
Again, looking to the future, when the UK frameworks are established—and they must be established by consent—we should look at ways in which we can entrench them, be it by statute or, as the Welsh Government have suggested, a UK council of Ministers, so that the UK Minister does not act as the English Minister in imposing a solution but that there is respect among the different nations of the United Kingdom and their Ministers. In that way, we can move forward. If it is by establishing these relationships and providing suitable mechanisms that we take the United Kingdom further down the road to federalism, then the very dark cloud of Brexit may yet have a silver lining.

Lord Hope of Craighead: My Lords, it is a pleasure to follow the noble and learned Lord, Lord Wallace of Tankerness. I too congratulate the noble Lord, Lord McInnes of Kilwinning, on the way in which he introduced this important debate, coming as it does between the disappointment of last week in the House of Commons and our engagement next week in the Second Reading of the withdrawal Bill.
As I think everybody knows, the proposals in the Bill as it stands were described by the Scottish Minsters when they first saw them as a power grab. At first hearing, one is inclined to treat an expression of that kind, especially coming from Ministers in a Government that still seem to be planning a second referendum on independence for Scotland, as somewhat overblown and exaggerated. However, on closer examination of the Bill and what it seeks to do to the devolution settlements for Scotland and Wales, which have operated successfully for many years, there is some force in the point that the Scottish Minsters were making.
Of course I must avoid going into matters which we will discuss in detail next week at Second Reading, but there are provisions throughout the Bill, not just in Clause 11, that propose giving powers to Ministers of the Crown to do things by means of regulations in connection with withdrawal which could intrude to a major degree into areas where the devolved Administrations have devolved competence, without the consent—or even seeking the approval—of Scottish and Welsh Ministers.
This is not just a complaint about Henry VIII powers; if I may say so, there is a touch of Oliver Cromwell about this, too. There are powers which, unless controlled in a way that the Bill does not currently provide for, would seriously invade and undermine the way that devolved government is conducted at present in Scotland. They appear to centralise control and decision-making in the UK Government in areas of devolved competence, in a way that would seriously limit the ability of the devolved Administrations to deal with the consequences of withdrawal as they see fit. This may not be the Government’s intention, but as the Bill stands that is how it reads, which was why the Scottish Ministers said what they did.
The Motion asks what the role of the devolved Administrations is to be on withdrawal. To some extent, this is really a matter for the UK Government, who are, after all, the architects of the withdrawal. They should answer that question and we, I am afraid, are at a disadvantage in this House in that the party in government in Scotland has no one here who is in a position to speak for it. But, from such public statements as I have seen, the position of the devolved Administrations is quite easy to understand. It has the support of all parties, particularly in Scotland, as I think was made clear in a debate yesterday. It is fairly straightforward and not really in doubt. These statements show that the Scottish Ministers—I mention them particularly—appreciate that some EU competences cut across elements of both devolved and reserved powers, so we need to find a way, by the creation of appropriate frameworks for matters of common interest, to preserve the single market for goods and services throughout the United Kingdom.
The noble Lord, Lord McInnes, said that this was a matter for mature debate, and I entirely agree. It is also a wonderful opportunity to create something new in place of the void created by the removal of the constraint on EU competences on devolution, which now goes. There is a need to create something new, but UK Ministers must appreciate that those frameworks will have to respect the principles and structure of the  enactments which created the devolution settlements in Scotland and Wales, and no doubt in Northern Ireland, too. That, for the Scottish and Welsh Ministers at least, seems to be a red line which must not be crossed. For my part, I see force in the position they are taking.
The settlement for Scotland, which I know best and have worked with for quite some time, has existed since 1998. The basic principle on which that Act was based is, as the noble and learned Lord, Lord Wallace, said, that everything which is not reserved is devolved. The reserved areas are set out in Schedule 5 to that Act, which has stood the test of time. There has been no lack of clarity about it. I have been waiting since 1998 for challenges to things to come before the Supreme Court; they have not emerged, because the system works. It is to those reserved areas that the frameworks must direct their attention. The position of the devolved Administrations is quite simple: they seek to be assured that things will be done only with the consent of the Scottish and Welsh Ministers in areas which are devolved.
I have to confess to some sympathy with the Minister and the Secretary of State for Scotland, to whom he is answerable. They cannot say so, but I sense that the absence of agreement so far about the framework is due not to lack of effort on their part but to policy demands at a higher level in the Cabinet Office. I noticed that the Minister for the Cabinet Office said in debate on Report in the other place last week that he and his team are actively taking forward discussions, with a view to bringing forward amendments in this House. That is very much to be welcomed. However, those discussions must proceed on the basis that there is no point in bringing forward amendments here which do not have the agreement of the Scottish and Welsh Ministers. This is because there will be no prospect of legislative consent being given to this Bill by the Scottish Parliament unless the Scottish Ministers are able to say that it has their agreement, and I believe that the same is true for the Welsh Ministers too.
I do not detect an unwillingness on either side to continue these discussions, but I hope very much that UK Ministers will find their way to constructing frameworks that fully respect the established boundaries between devolved and reserved powers. They need to secure the agreement of the Scottish and Welsh Ministers, and they will, if they respect those boundaries. I look forward to discussing these issues further in our debates in following weeks.

Viscount Younger of Leckie: My Lords, we are tight on time this morning. I would be grateful if Back-Bench speeches could firmly be concluded as the clock reaches seven minutes. In that way, Front-Bench speeches will have their full allotted time.

Lord Lang of Monkton: My Lords, I will try to be brisk but not brusque. To follow a speech by the noble and learned Lord, Lord Hope of Craighead, is always an invaluable education, and I shall read his speech afterwards, as will others, I am sure. I must comment on the undue modesty with which my noble friend Lord McInnes introduced the debate. He laid it out brilliantly for us, and we are grateful to him for  opening up this subject for debate today, although with the Second Reading of the European Union (Withdrawal) Bill next week it feels a little like a Committee stage ahead of Second Reading. We are still waiting for the long-promised amendment and without it the debate is a bit like “Hamlet” without the prince.
Nevertheless, I particularly welcome the positive tone of the second part of my noble friend’s Motion, and I hope to find time to say a word or two about that. I found much to agree on with earlier speakers. There is a positive tone in this House and I hope in Parliament as a whole over how to address these negotiations, but sadly the positive tone is not to be heard much from Scotland, least of all on Brexit. The persistent calls for the unattainable are rebuffed not by the Prime Minister or by this Government but by such names as Barroso, Juncker, Van Rompuy and Tusk, because that is where they have been applying. They have made it consistently clear to the Scottish Government that Scotland is not a sovereign nation state—something that was settled firmly, again, in 2014—and therefore special deals on such things as the single market or anything else are not in the EU’s gift to the Scottish Administration.
If the Scottish Administration want something gloomy to talk about, they could focus on their record on Scotland’s economy. Rather than using a crystal ball, they could look at the past 10 years which, according to a Fraser of Allander report, show output per head in Scotland growing by only 1.2% compared with 4.2% in the United Kingdom as a whole. Forward projections remain equally poor, and in Scotland we are teetering on the edge of a recession. That is probably why the Scottish National Party prefers to talk about Brexit.
The fact is that if the Scottish Administration would but admit it, the Government’s commitment to working with them on Brexit is strong, and so is their record. On her first day in office, the Prime Minister went straight to Scotland to talk to the First Minister. In the White Paper that came out a year ago, the maintenance of all the interests of all the parts of the United Kingdom was a very high priority in the list of priorities. The Joint Ministerial Committee has found new life with the development of the European negotiations sub-committee, and in other forums there have been many meetings, so there has been a constant emphasis on consultation and working together carrying through into the withdrawal Bill next week.
In a report published last March by the Constitution Committee ahead of the publication of the withdrawal Bill, we stressed the need for consultation and co-operation between the Government and the devolved Administrations and that they would need to manage the new interfaces and potentially overlapping responsibilities between reserved matters and devolved competence in areas where the writ of the EU would no longer run. That consultation and co-operation has been happening, mainly through the use of the Joint Ministerial Committee and the EN sub-committee, with repeated comments that talks are going well and with agreement on principles for the common frameworks reached last October, so it is not all bad. It seems to me that the body of legislation returning to the United Kingdom has to come, in the  first instance, to the nation state, the entity that the EU recognises and that is handling the Brexit negotiations. But it is equally clear that many of the repatriated powers should pass on as quickly as they can, if not immediately, to the devolved Administrations within whose competences the subjects lie. Equally clearly, where the national interest dictates, some specific powers should remain at Westminster.
So diverse and varied is the range of forms and status of EU legislation accumulated over the past 40 years and more, and so complex the task of absorbing them into the appropriate legislative form within the United Kingdom and for the devolved Administrations, against a looming deadline and the possibility of further last-minute amendments from Brussels, that it feels not so much like a three-dimensional jigsaw as a kaleidoscopic whirlpool. So it is not surprising that while some measures fall clearly to the sovereign Parliament to take, and others clearly to the devolved ones, a few in the middle will still pose problems.
For example, in agriculture, as has been mentioned, the possibility of trade deals inhibits full devolution at present. On the environment, some aspects will require national uniformity in the interests of all of us. There will be some pieces of delegated legislation that flow from the European Communities Act that, once repatriated, would be better placed not in delegated legislation but in primary legislation. These are the issues that can fall into place over time, but they have to be handled with understanding on both sides. It is important, however, to stress that not one of the powers the devolved Parliaments hold at present will be lost in this exercise: what they have, they will hold, with many more to come shortly. So there is no question of a power grab, and it is a pity that bogus claims of that kind should be introduced to distort the picture and poison the atmosphere.
The Motion speaks also of,
“future opportunities for strengthening the union”,
which is a welcome, positive approach to something that is still fraught with difficulty. My noble friend Lord McInnes was kind enough to refer to two reports produced by the Constitution Committee a couple of years ago on precisely this subject. They were debated last October, so clearly for two years the Government considered that we had given them food for thought. I will paraphrase them as concisely as I can.
The first report addressed the union itself and argued that any further consideration of constitutional change should include the interests of the union as paramount, and that nothing should be done to its detriment. There should be no more “help yourself” devolution, without a thought for the wider consequences. The second, on intergovernmental relations, argued that the Joint Ministerial Committee should be developed in a much more consensual and even-handed way, with numerous improvements to its use and procedures. We also called for a new mindset in the relationship between the UK Government and Parliament and the devolved Administrations, whereby United Kingdom departments would abandon the “devolve and forget” habits that seemed to have taken seed in many of them  around the country and to afflict some of them, and instead introduce much closer relationships, particularly on policy development.
The Government’s response to these recommendations was less than wildly enthusiastic, although they did claim that much was already being done. I echo the thoughts of those who have urged that they have another—indeed a continuing—look at the various suggestions we made. I hope that things are improving and that that will be carried forward further in the future.
But of course, good will on both sides is needed. One has to hope that, over time, the devolved Administrations will shed their apparent resistance to the hand of friendship and settle down to make their powers work better, for the benefit of their citizens.

Baroness Humphreys: I too am grateful to the noble Lord for initiating this debate and for affording me the opportunity to contribute to it. My grateful thanks also go to my noble friend Lord Thomas of Gresford, who unfortunately cannot be here today and whose suggestions I have incorporated into my contribution.
So far, and despite warm words, the UK Government have denied any meaningful role to the Welsh Government in the negotiations for withdrawal from the EU. The Joint Ministerial Committee, the consultative body set up to co-ordinate relationships between Westminster and the devolved Administrations, meets only once a year. On 24 October 2016, with the Prime Minister in the chair, it agreed to set up a subsidiary Joint Ministerial (EU Negotiations) Committee, whose purpose was to seek a UK approach to, and objectives for, Article 50 negotiations.
At the first meeting of the new committee on 9 November 2016, chaired by David Davis, with the Secretaries of State for Scotland, Wales and Northern Ireland and Ministers from the devolved Governments in attendance, it was agreed to develop a work programme to ensure its connection to and involvement with the process of negotiations. Ministers agreed to meet monthly to share evidence and to take forward joint analysis that would inform that work programme.
Meetings took place monthly until February 2017, but then the committee ceased to meet for eight months. The undertakings to work constructively together were flouted. During that gap, the Government served the Article 50 notice in March and negotiations with Michel Barnier began in June. The devolved Administrations were left out in the cold. Their frustrations were expressed in a letter from the Welsh and Scottish Secretaries to Mr Davis on 15 June. They complained that from the beginning the UK Government had used the meetings of the Joint Ministerial (EU Negotiations) Committee merely as an opportunity to rehearse their own well-published positions, and that there were no meaningful discussions on key issues with a view to all-round agreement. They sought agreement as to how the devolved Administrations would be represented in the negotiations, and asked for the resumption of regular meetings to fit in with the cycle of talks with Mr Barnier. They were also deeply concerned about  the lack of engagement with them on the proposed great repeal Bill. They wanted discussions on future constitutional arrangements for joint frameworks and on the vital issues of replacing the existing funding streams for EU structural and agricultural funds. Their letter was ignored.
Meanwhile, in July the European Union (Withdrawal) Bill was published. It began its stages through the Commons in September. Members of all parties in the devolved parliaments were concerned to read in the Bill that the UK Government proposed to take over from Brussels all the existing powers exercised by the EU. That included 64 areas of government that have all been devolved to Cardiff, including the environment, fisheries, agriculture and trade. The proposal was and is that only Westminster can dictate changes to retained EU law. The main mechanism for these changes is by way of ministerial diktat in the shape of statutory instruments or Orders in Council.
I turn to the future of the Welsh economy and the prosperity of Wales. Under the existing Brussels regime, decisions on funding—for example, on agricultural support or structural funds for deprived areas—have been based on need, but UK Governments base their funding of devolved Administrations not on need but on the heavily criticised Barnett formula, which is based upon a crude population headcount. Under the provisions of the withdrawal Bill in its present form, nothing will prevent Ministers changing the basis of funding from the EU model to a Barnett-type model. The balance of power at Westminster tilts heavily towards England—that is where the bulk of the voters are—and no doubt domestic English politics will become a major factor in distributing funding.
What role do the Government now envisage for the devolved Administrations in the negotiations for a trade deal with Europe that are about to start? Will the Government undertake to put the Joint Ministerial Committee and its offshoots on a statutory basis? Are they prepared to use the Joint Ministerial Committee as a forum not just for consultation but for agreement on the UK-wide frameworks which need to be put in place? Will they, finally, base their funding decisions on need?
The Motion speaks of strengthening the union, but that depends on the devolved Governments being treated with parity of esteem with the UK Government in the Brexit negotiations and what follows afterwards.

Lord Kerr of Kinlochard: It is a pleasure to follow the noble Baroness, Lady Humphreys, and I agree with virtually everything she said. The noble Lord, Lord McConnell of Glenscorrodale, started with Burns, and I think the text for our debate should be:
“O wad some Power the giftie gie us
To see oursels as ithers see us!”.
We do not know enough of the facts of what is going on between the devolved Administrations and the central Administration, but the perceptions around are worrying, and I want to talk about the perceptions.
I have bored the House about this before, but it is a great pity that the governing party in Scotland is not  represented here in our debate to tell us what it thinks is and should be going on. I hope that if the recommendations of that other Burns—Terry not Rabbie—are put into effect, it will become impossible for the SNP not to be represented here. If, when they are democratically entitled to a finite number of seats, they choose to leave them vacant, they will be following the policy of Sinn Fein in the House of Commons, whereas the SNP Members of the House of Commons are making a very important contribution to the Brexit debate, and there should be SNP representation here. If they do not change their policy, the perception in Scotland will be that they are letting an arcane point of party theology get in the way of representing the best interests of Scotland in this debate.
I shall make three points. The first is one that the noble Baroness, Lady Humphreys, made more clearly than I could. It is absurd that the co-ordinating committee did not meet between the beginning of February and the middle of October last year. A committee set up to provide oversight of the negotiations did not meet at all. That was a mistake.
It was a mistake, in my view, that the devolved Administrations were not consulted before either the Lancaster House or the Florence speeches. It was a mistake, in my view, that central government did not focus on and take seriously the Welsh proposals for a dispute settlement procedure and the Scottish White Paper of 2016. I hope they will take seriously the economic White Paper published just the other day on the macroeconomic effects of leaving. They should at least go through the motions of taking these things seriously. The perception is that it is a little insulting if one does not have a dialogue. The perception—a silly perception, perhaps—is that Boadicea’s chariot rolls ahead and the subject Celtic races are scattered at her chariot wheels.
As for the Bill, the noble and learned Lords, Lord Wallace of Tankerness and Lord Hope, are much greater experts than me, but it seems on the face of it that Clause 11 means that in areas of devolved competence, UK Ministers are in future to be free to legislate without seeking the consent of Scottish Ministers. While the UK Government may amend retained EU law, the devolved Administrations are required to keep that constraint on their action: they are not allowed to divert from retained EU law. So the perception in Northern Ireland, Wales and Scotland is bound to be that not only are they not taking back control, they are losing a bit of the control that they already have. I do not know the facts—I can judge the Bill only by what is said in it—but this is a very dangerous perception to have.
I understand that there is a concordat that the devolved aspects of proposed legislation are meant to be squared away between central government and the devolved Administrations, if there are any devolved aspects, before Bills are published. Clearly that did not happen in this case, as all amendments to Clause 11 have been rejected, and we are told we must wait. I have a high regard for Mr Lidington; he is a skilful negotiator, and I hope he can crack this problem. Like the noble and learned Lord, Lord Hope, I do not think that should be a particularly difficult problem.  If it is not cracked with sensible government amendments, we in this House will have to do our best to correct the Bill. It is dangerous that the perception is widespread—I cannot speak for Wales and Northern Ireland but certainly it is in Scotland—that Mr Davis did not care very much about the views of the devolved Administrations. Perceptions matter.
Another point, which is much more delicate and difficult—and on which I am not an expert—is that Northern Ireland voted to remain. It is represented in the other place only by a party that wanted us to leave. That party support is now crucial to the survival of Mrs May and the Government. As Stormont is suspended, there is no democratic forum in which the views of the majority, who voted to remain, can be presented and debated. That strikes me as a very dangerous situation, and I am alarmed that it runs on. There is a risk of the perception that it suits the DUP very well. I was very sorry that Mr Brokenshire had to step down. I have never met Mrs Bradley but I wish her well. I note that in the past, in the days of Mr Major and Mr Blair, it took the personal involvement of the Prime Minister to crack heads together in Belfast. I recall at least one occasion when the only thing on which Mr McGuiness and Mr Paisley agreed was that a proposal put forward by Mr Blair was absolutely and completely wrong. That is a start.
Are we sure that we are being sufficiently proactive? This stalemate has run on for a very long time. I do not know when the Prime Minister will herself conduct talks in Belfast but she will have to do so. The perception, which may be unfair, that she is staying aloof and keeping out of it is very unfortunate. As the lawyers in Brussels attempt the impossible task of turning into treaty language that absurd December formula on the frontier, “internally inconsistent” can make sense only if either the Republic elects to leave the customs union or the UK as a whole elects to stay in the customs union. Neither Mr Varadkar nor any political party in Dublin recommends the former course and the Prime Minister has shut her face right from the start against the latter course.
I do not know how the Government envisage squaring the circle. Any solution will require enhanced political dialogue with and among the political leaders of Northern Ireland. We need to avoid the perception that the London Government are interested in only the views of the minority in Northern Ireland who voted to leave the European Union.

Lord Wigley: My Lords, I am delighted to follow the noble Lord, Lord Kerr, who has rightly pinpointed some of the dismay felt in Wales and Scotland at the implications of Clause 11. I shall come back to that.
I welcome the timely opportunity to debate the role of the devolved Administrations in the context of the UK’s impending departure from membership of the European Union; and I thank the noble Lord, Lord McInnes, for facilitating it. I hardly need to repeat that I greatly regret that Wales will be leaving the European Union, which has been so beneficial to Wales, and I  am dismayed that my country—though not my county—voted to spurn the hand which has, over the past two decades in particular, nurtured it.
The Motion refers to strengthening the union, though, as we have heard, that does not refer to the European Union but to the United Kingdom. There has of course been no great outcry in Wales and Scotland to tilt at the monarchy, but there has been widespread discussion of the changing nature of the UK as a political state. All parties have signed up to support greater devolution of power to Wales and Scotland, and to Northern Ireland, if it so wishes. The nature of the UK as a state is an evolving relationship of free and equal partners. The Scottish referendum of 2014 underlined that the people of the respective nations of the UK have a right to their independence, if they so wish. That is a freedom greatly envied in other parts of the world, such as Catalonia. We have an evolving union of the nations of these islands; that relationship between our four nations—I include the whole of Ireland in that context—is an evolution that will undoubtedly develop over the coming years. Our relationship with our fellow members of another union—the European Union—will be a significant factor in how things unfold.
We shall be discussing the EU (Withdrawal) Bill at Second Reading next week. I do not want to anticipate that debate, but we shall undoubtedly address the Bill in the light of comments—and commitments—made in the House of Commons during its passage there. It is clear that the EU (Withdrawal) Bill, in its current form, would weaken the devolution settlements that the people of Wales, Scotland and Northern Ireland have enjoyed over the last 20 years.
The Government have made it clear that Clause 11 is not good enough and have said that it will be amended. That is the clause dealing with powers repatriated from Brussels, of course. The issue, as other noble Lords have mentioned, relates to powers currently exercised on an EU level but which relate to functions devolved to Cardiff, Edinburgh and Belfast. The issues that arise in that context relate mainly to three aspects: first, whether the powers will be transferred directly from Brussels to the devolved regimes and not retained at the UK level; secondly, that there should an acceptable mechanism for ensuring that the use of those powers, whether by Cardiff, Edinburgh, Belfast, or indeed Westminster, do not distort the UK single market; and, thirdly, that all four Governments have equal standing, in their own right, in any co-ordinating forum set up for this purpose.
The Scottish Secretary made a strong commitment before Christmas that Clause 11 would be amended on Report in the Commons, based on criticisms relating to these matters made across the House in Committee. The British Government have failed to fulfil that promise. They did not table any amendments that address concerns raised by Members of all parties, across both Houses, with regard to this aspect of devolution. It is as if the UK Government have difficulty accepting that there is more than one nation and more than one Parliament within the British state.
Last Wednesday, 17 January, the National Assembly, our Senedd, rolled up its sleeves—to use the term used by the noble and learned Lord, Lord Wallace—and  voted unanimously in favour of Steffan Lewis AM’s proposal for a Welsh continuity Bill, to introduce legislation to enshrine EU laws in devolved areas into Welsh law before Westminster gets its hands on them. Plaid Cymru has long advocated a continuity Bill as a means of pre-empting and mitigating the potential power grab by the UK Government. This was never the preferred option, but now that the EU (Withdrawal) Bill has passed through the Commons with no changes to Clause 11, it is widely regarded as essential. The constitutional encroachment of Westminster in the context of the Bill is so great that it is not only Plaid Cymru AMs who now support this continuity Bill to protect Welsh democracy. Last Wednesday, it was supported by every party: the Labour/Liberal Democrat Welsh Government, the Welsh Conservative Party and even UKIP. In the light of this unanimous vote of the Senedd, the Labour Government of Wales are moving towards putting forward their own continuity Bill, which they have already drafted. If they are serious in this commitment, they must do so urgently before another Westminster power grab, embodied in the Wales Act 2017, further restricts their authority.
The UK Government must also recognise this landmark vote in Wales. A decision of this magnitude cannot be ignored. Yet, when my colleague, Plaid Cymru’s parliamentary leader, Liz Saville-Roberts MP, asked the Prime Minster last week whether she would respect the decision made in the Senedd, the Prime Minister sidestepped the issue, dismissing by default the concerns of her own Conservative Party in Wales.
My party’s position in the long run is clear: we want the people of Wales to run our own affairs. In the interim, we will need a collaborative procedure for the creation of UK-wide frameworks, given that this Government are so determined to press ahead and remove us from the existing EU frameworks. These UK-wide frameworks will have a significant impact on the existing devolution settlements and therefore must be created jointly by all the sitting Governments, not dictated by Westminster Ministers. This is only the first step to ensuring that devolution is not just respected but upheld in the upheaval this Government are creating by leaving the EU single market and customs union.
The existing Joint Ministerial Committee on EU Negotiations had a rocky start. Until recently, it had been suspended, as has been mentioned, and the reshuffle took place during what should have been the opportunity for the Government to amend Clause 11, which could have addressed the concerns I have outlined. The JMC has proved better than nothing at enabling devolved Administrations to engage in decisions that have an impact on their people. The principles that underpin the JMC were agreed to ensure close working between the UK Government and the devolved Administrations on reserved and excepted matters that impact significantly on devolved Administrations. A communiqué issued by the JMC on 16 October agreed that these same principles should apply to common frameworks. It stated that the creation of any new frameworks will be a matter for “all parties to agree”. I would support the creation of a joint council of Ministers in that context, as mentioned by the noble and learned Lord, Lord Wallace of Tankerness.
We shall undoubtedly return to these matters in the context of the Brexit Bill. In the meantime, I invite noble Lords to contemplate the likely impact of the Government’s Brexit policies on the harmonious co-operation between the nations of these islands.

Lord Bew: My Lords, I too thank the noble Lord, Lord McInnes, for securing this debate. I listened with great interest to noble Lords who spoke about the thesis of a power grab and the argument in the Scottish and Welsh Administrations.
The tone of the debate has been subtle, conciliatory and very helpful. However, I add for the sake of balance that I think that our Library briefing would have been improved by a reference to the article submitted to the These Islands forum by an Oxford don, D H Robinson, entitled, Continuity, Devolution, and the EU Withdrawal Bill. There is a slight tendency in the briefing for quotes on all aspects of this problem to head off towards the “Oh, woe is me” tone. Therefore, perhaps a moment of balance is required.
Regarding the problems of the missing leg of devolution—the fact that there is no devolution in Northern Ireland—I wish to take up something mentioned by the noble Lord, Lord McInnes, when he referred to the LucidTalk poll. I understand exactly what drove him to comment on that at this time. Like him, I voted remain, largely because I thought that leaving would be destabilising for the union—and indeed, I think that it has been destabilising. But it has not been destabilising in quite the way that the noble Lord suggested on the basis of that poll. What it has done is enrage the most moderate Irish nationalists on both sides of the border. It is indisputably a problem. My fears on that, and my support for remaining in the European Union on that basis, have been entirely justified.
However, there is no weakening in support for the union among its supporters. In the last general election, the pro-EU Ulster Unionist Party took a terrible hit while the share of the vote for the Democratic Unionist Party—the Brexit party—went up markedly. The most reliable poll in Northern Ireland, the Life and Times Survey, taken after the referendum, shows that the numbers of those supporting the union and those opposing it remained more or less where they were previously. The LucidTalk poll asked participants, “What do you feel about a hard Brexit?”. The truth is that every citizen in Northern Ireland believes that a hard Brexit means that when they try to drive to Dublin Airport en route to their holiday in Marbella, they will be stopped by a soldier. If you ask people that question, you will get a response which reflects their nervousness. However, I do not think that that is a very likely proposition. So, if the noble Lord will forgive me, that is my comment on his remarks on the LucidTalk poll.
However, there is a point—already referred to by the noble Lord, Lord Kerr, when he talked about paragraph 49 in the progress report—which is now making the return of devolution important. The agreement made between the Prime Minister and the European Union to allow the development of talks  includes an ambiguous paragraph. Until now, Stormont has not contributed to the debate on Brexit. My view is that it would have had little to say and that, until now, we have not lost so much because of this problem, but that we will start to lose out very soon unless we get a return of Stormont. That is because in the preferred solution in paragraph 49—which is ambiguous and a fudge—the UK Government promise, in the absence of wider solutions which might otherwise be negotiated, to,
“maintain full alignment … which, now or in the future, support North-South cooperation, the all-island economy and the protection of the 1998 Agreement”.
There are big arguments about what that means. As far as I can see there is no common agreement between the UK Government and the European Union about what the word “alignment” means. Some, like Andrew Neil, believe that it is purely local in its significance, for example when it refers to Ireland, while those like the well-known economist David Blanchflower believe that it is a wider understanding between the European Union and the UK. However, there is no doubt or ambiguity about the central role in this formulation of the protection of the 1998 agreement—the Good Friday agreement, which sets up Stormont. What is not in doubt is that the heart of the agreement is that the current north-south arrangements, which envisage certain points of harmonisation or alignment, or whatever word you want, by agreement between north and south, will continue and will be the core of a resolution of this question. However, if there is no Stormont, the commitment in paragraph 49 becomes ethereal indeed. There needs to be a working Stormont and there need to be the models of consent and agreement that have developed quite effectively over the last 19 years. The north-south arrangements have been remarkably uncontroversial. However, Stormont needs to be in place for this compromise to have any meaning at all.
I conclude by wishing the new Secretary of State good luck in her work in trying to bring about the return of devolution, because it is now very important. She has some cards. The promise of a reduction in corporation tax for Belfast could be significant, and the great advantage that the Irish Republic has had in this matter is now under threat from the increasing and intense militancy from France, Germany and the European Commission against the Republicans’ tax arrangements. You could also have a more level playing field in the island of Ireland. That must be an attraction for the return of the devolved Assembly.
Even in the event of a failure to negotiate, it is not just a question of saying that the British Government are against joint authority—which they are. The Government must make it clear that they do not have in their mind’s eye any form of future settlement that is a conversation between two Governments but from which unionists are excluded. Although I do not believe—for reasons that we in Westminster are all aware of—that it is in the British Government’s mind’s eye, I do not think that the Irish Government fully understand that. They have to do that for two reasons: first, so that the nationalists do not believe that they can sit on their hands and will then be rewarded by something that they can call joint authority; and secondly, because the  unionist community will have to make concessions in areas such as Irish language, and they need to have the confidence to be able to do that.

Lord Suri: My Lords, Brexit must be a moment of national renewal. Should it appear to be a moment of national stagnation, any changes that we make can be reversed by future generations with ease. With that in mind, let us turn to the future of the union.
I have been a consistent supporter of devolution in this place, and I have also been looking at the case for an English Parliament, which might strengthen the union. Brexit provides a chance to send a great number of powers to our three devolved Parliaments, especially on rural affairs, and I have been disappointed to see the ongoing tussle between the Government and the devolved Administrations.
In particular, I have grave concerns about the Scottish devolution settlement as regards legislative power. As it stands, the principle that holds the devolution settlement in place is that all policy matters are devolved to Scotland unless they are specifically reserved. The Government may choose to reserve or devolve more powers, but the reservation of additional powers ought to be done with the express consent of the Scottish Parliament. However, the withdrawal Bill, which has recently come here from the other place, seems to create a new principle.
As we heard earlier, Clause 11 of that Bill would allow the UK Government to change laws in areas currently devolved in a way that would previously have run contrary to EU law. However, the Scottish Government will not have the same power. I struggle to see how this new way of working is consistent with the principles laid out in the Scotland Act and I hope that there will be some creative thinking on it from the Government. I have worked with the new Minister for the Cabinet Office in the past, and I hope that he can find some consensus on the Joint Ministerial Committee, on which he now sits.
My second point is on Northern Ireland. I have spoken before in this place about the unfolding collapse of power-sharing and my deep regret at the current state of affairs. The Secretary of State has announced what must be at least the fifth new round of talks between parties in the Assembly, but it would be fair to say that few think that a new deal is likely to follow.
In the last round of the Brexit negotiations, the can was kicked down the road on the issue of the border. I understand why, as trade issues are closely linked to the future status of the border and both discussions need to be concluded at the same time, but this may require some unorthodox thinking. If the whole of the UK follows EU rules in the areas codified in the Good Friday agreement, that ought not to be a problem, as the Government can legislate for the whole of the UK, but if a deal is reached that agrees regulatory shadowing of EU laws, such shadowing will need to be, first, devolved and then passed by the Assembly. However, in the absence of an Assembly, what will happen?
These pressing issues of the border underline the desperate need for either the return of power-sharing  or direct rule. My preference is for the least obstructive border consistent with leaving the single market and the customs union, even if it forces the whole of the UK into following some EU laws. Peace on the island of Ireland is more important than any lost trade opportunity. It is hard won, and our duty is to keep it for future generations.

Lord Eames: My Lords, we welcome the opportunity before next week’s extensive debate to look beyond Brexit—an opportunity given to us this morning by the noble Lord, Lord McInnes—and those of us coming from the devolved part of the kingdom are particularly grateful.
The noble Lord, Lord Kerr, has recently reminded us in a very forceful manner, based on his wide experience of such matters, of the tragedy that is at present occurring in Northern Ireland, which is an integral part of the union.
The tragedy that he has drawn to our attention with such detail and sensitivity, and which is coming before us as we approach the inevitability of the Brexit situation, can do a great deal to remind us of what happens when devolution fails and presents us with questions which do not have a pat and easy answer—particularly in Northern Ireland, where the two main parties have struggled to reach an agreement in restoring the Administration at Stormont. This has only added to a burden which those of us who have lived through the darkness of the past and have tried to make a contribution in bridge building and healing the wounds of that community feel deeply about at this time.
The noble Lord, Lord Kerr, has rightly spoken about the relationship in this situation between central government and, particularly, the devolved Administration in Northern Ireland. He has drawn our attention in a forceful manner to the tragedy, as we approach Brexit, involving the Government as a representative of us all without the co-operation and involvement of a Northern Ireland Administration. Given the past and how far we have come, and given the progress that has flown in the face of what people predicted was impossible but has in fact been achieved, this has only added to the tragedy. It has added not only to the political situation but, most importantly, it has added to the situation of ordinary people going about their ordinary lives who are asking questions of a fundamental nature without realising their significance. Those questions are to do with whether their voice will be heard in the new post-Brexit situation. Will there be in the negotiations a reassurance built more on what has been promised and can be delivered; or, as the negotiations continue and there is bound to be compromise and shifting of situations, are the vital assurances given to the devolved nations likely to be fulfilled and settled in concrete? Those are the kind of questions that the man in the street is asking and that we in this House should be unafraid to ask and seek an answer.
I urge the Minister, in his response to what has been said today, to address the issue of public confidence in central government assurances. How far will those assurances go? In my position, I liken that to the question of the Irish border. Much has been promised  and offered, but they are words. Returning to the contribution of the noble Lord, Lord Kerr, again I reiterate, where is the Prime Minister? Where is the power and influence of the Prime Minister to help us to get a solution to the stalemate? In the eyes of the Government it may be a simple act of asking for her and her officials to be involved in some form in the discussions taking place, but symbolism and perception are important. Symbolism and perception have more to do with the reality of success than many hours spent round the table arguing.
Again I support what the noble Lord, Lord Kerr, has said: given the situation in Northern Ireland, there is an urgent need for greater sensitivity from central government towards the particular needs we face. I have been through this situation. A year ago I said to this House that there is no doubt that the border issue is much more than a line on the map. The border issue, which is so much a part of discussion in this House and elsewhere, has more to do with relationships, with the Irish story, with our culture and, above all else, with our divisions—which have more to do with the mind and the heart—than a line on the map. I get angry when I hear references to this issue as purely and simply a geographical extension of what is to become the border between the United Kingdom and Europe. There is much more to it than that. I hope the day is not far away when the Government will realise the utter sensitivity of issues such as the border to the future of Northern Ireland.
Another point we need to remember is that the generation which will face post-Brexit Northern Ireland has learned most about our troubles from the history books. Many have not been through what we have been through and have not had to answer the issues of human need and suffering. Therefore, when we talk about the progress that Northern Ireland as a devolved Administration has made, let us not forget that the post-Brexit generation will have learned most of these things from history. I beg the Minister to remember these sensitivities.

Baroness Smith of Newnham: My Lords, like other Members of your Lordships’ House, I thank the noble Lord, Lord McInnes, and congratulate him on introducing this debate. Even though most of my ancestors were Irish or Cornish, I speak in the debate today as one of the few people from England rather than from one of the devolved nations, Although I like to think that I might be entitled to an Irish passport I believe that I am not entitled to one and I shall speak, therefore, to the second part of the title of the debate and refer to the opportunities for strengthening the union of the United Kingdom.
As my noble and learned friend Lord Wallace of Tankerness pointed out, the Liberal Democrats is the one party which is unambiguous in its support for both the United Kingdom of Great Britain and Northern Ireland and for the European Union. For us, the two unions have long been important.
In her maiden speech in the other place, the late Jo Cox MP said there is more that unites us than divides us, and yet just a week before the referendum in June 2016 she was tragically killed. The debates  ahead of the referendum began to highlight some of the deep divisions in the United Kingdom, and the vote to leave the EU on 23 June highlighted many other divisions—obviously between leavers and remainers but also between the metropolitan elites and those who felt left behind. There are people for whom the idea that reducing roaming charges is a great benefit of the European Union, but how is that a benefit if you never travel abroad? There is division between the elites—those people who are seen as having a particular interest in membership of the European Union—and those for whom EU membership seems to offer very little. There are divisions between urban and rural areas and, most importantly for today’s debate, differences between Scotland, Wales, Northern Ireland and England.
When travelling to north Wales just after the referendum I spoke to someone—we were travelling to a meeting together—who said, “I am regretting coming to Wales because they all voted to leave”. I said, “That is not quite true—they did not all vote to leave”. She said, “I suppose you are one of those leavers then”. I said, “No, I am not. In fact I am a Liberal Democrat remainer but I feel it is necessary to point out that while a majority of people in Wales voted to leave it was not all the Welsh people—just as it was not all the English people voting to leave or all the Scots and people in Northern Ireland voting to remain. Occasionally we have to remember these things”. I sighed a bit and went into the dinner, where somebody sat next to me and spent the whole evening telling me why it was absolutely essential that we had to leave the European Union, rehearsing all the arguments we had had before. I thought, “This Brexit process is going to be rather long and rather tedious”. So, in many ways, it is proving.
When she became the leader of the Government, Theresa May stressed the importance of healing divisions. Then in January last year in her Lancaster House speech she stressed not just a general healing of divisions but the importance, as she put it, of,
“the preservation of our precious union”,
which was going to be put,
“at the heart of everything we do. Because it is only by coming together as one great union of nations and people that we can make the most of the opportunities ahead”.
Obviously that is what the noble Lord, Lord McInnes, thinks, yet so far we are not seeing that great coming together. How often do people in England bother to think about the interests of Scotland, Wales or Northern Ireland? It is perhaps rather less than the EU27, because one of the key issues brought to the fore in the first phase of negotiations was precisely the situation of Northern Ireland, the relationship with the Republic and the issue of whether there would be a border, or what sort of border there would be between the north and the south. We have already heard from the noble Lords, Lord Kerr and Lord Bew, and the noble and right reverend Lord, Lord Eames, of the importance of those border questions. As a non-Irish person I have no intention of getting into the detail of Stormont and the devolved Administrations, but the question of Northern Ireland is a matter not just for the United  Kingdom, although it is vital for us, but for the European Union and the European Economic Area.
I was in Oslo two days ago giving a public lecture. People were asking, “What is happening about the border with Northern Ireland? What is going on? Please can you explain to me what is meant by the idea that there will not be a hard border?” There will be full regulatory alignment, which is obviously what the European Union and the Republic of Ireland want, yet it is not what Arlene Foster, the leader of the DUP, appears to want. She wants there to be no difference between Northern Ireland and the rest of the United Kingdom.
I would be most grateful if the Minister could explain to us—after so many months of negotiations, nearly two years after the referendum and rather closer to the point when we are meant to be leaving the European Union than voting on leaving it—what Her Majesty’s Government understand by having a situation where there is not a hard border, yet the United Kingdom is, we are led to believe, leaving the European Union, the single market and the customs union? If we do all those things it appears to most observers, whether in the United Kingdom, the EU27 or Norway, that we are trying to square an impossible circle. Finally, does he really believe that the Prime Minister is putting all the effort she could into ensuring that this “precious union”, as she calls it, will really be stronger in the event of the United Kingdom leaving the European Union and that the United Kingdom will not feel that its peoples are being divided and taken out in a way that damages their national interests?

Lord Bilimoria: My Lords, in the referendum both Scotland and Northern Ireland were among the strongest supporters of remaining in the EU, with majorities of 62% and 55.8% respectively. In Wales, 52.5% voted to leave the EU and in England 53.4% voted to leave. There is no question about it: the referendum has been a huge divide in this country. Many have said that it has been a demonstration of English nationalism. In the Supreme Court Miller case, the decision of the court was that devolved legislatures did not have a veto on the UK’s decision to withdraw from the EU. I thank the House of Lords Library for its excellent briefing notes on the matter.
The Scottish and Welsh Governments have described the Bill that is coming up—this debate is very timely before the European Union (Withdrawal) Bill reaches our House next week—as a “power grab”. The Government have said that they will come back to it, as the noble and learned Lord, Lord Hope, referred to in his excellent speech.
The Brexit White Paper of 2 February 2017 was based on the Prime Minister’s famous Lancaster House speech, in which she said very clearly that she would strengthen the union by securing a deal that works for the whole of the UK, as the noble Baroness, Lady Smith, just said.
What is the role of the devolved Administrations in this? The Government have stated their intention to fulfil Brexit responsibilities in close consultation with  the devolved Administrations. I ask the Minister: has this actually happened? The noble and learned Lord, Lord Wallace, gave the example of CETA. When Canada negotiated with European Union, it had members from each of its provinces at the table. Has this genuinely been the case?
We have the Joint Ministerial Committee on EU Negotiations, which I believe has met only five times between October 2016 and September 2017. Could the Minister confirm this? It has been described by a Member of the House of Commons as,
“a total and utter waste of time”.—[Official Report, Commons, 26/6/17; col. 417.]
Have they agreed the need for a common framework? What are these frameworks? Is it that between Northern Ireland and Ireland there will be only the land border, which I will come to later? The European Union (Withdrawal) Bill does not specifically mention a common framework. Could the Minister tell us why this is the case? I believe that in one of the Joint Ministerial Committee meetings they spent 45 minutes being told what the UK Government had decided, so did its members really have a say on it? Nicola Sturgeon has been very outspoken about this. She feels that the Scottish Government have been cut out of all the decision-making, which is a real shame whether you agree with her or not.
How much autonomy will the devolved Administrations continue to have over areas such as agriculture and fishing? It will be very complicated when it comes to issues such as this, especially when it comes to implementing new frameworks.
We then, of course, have Clause 11, which several noble Lords have mentioned. We are replacing that with a new restriction that devolved institutions cannot modify retained EU law. This will be a huge issue in the Bill. The reaction from Wales, which voted to leave, has been to put out, along with Scotland, a joint statement saying that this is a,
“naked power-grab, an attack on the founding principles of devolution”,
that, “could destabilise our economies”.
There is of course the convention that there is a requirement for the Government to seek a legislative consent Motion from each of the devolved legislatures for the Bill, which the Government have made it clear they will do. That is reassuring. The Welsh and Scottish Governments believe that devolved Ministers should have the same powers in respect of matters falling within devolved competencies as UK Ministers. I do not think that that is happening in this case.
In their rebuttal, the Government have said that this is not a power grab. Any durable solution will need the consent of all the nations the United Kingdom and all their elected representatives. A successful settlement cannot be imposed by the United Kingdom Government; it must be developed in partnership with the devolved Administrations.
We then of course come to the Irish border. This is absolutely ridiculous. In phase 1 of the negotiations, a joint report was prepared by the European Union and the UK that basically kicked the can down the road. It said:
“The United Kingdom remains committed to protecting North-South cooperation and to its guarantee of avoiding a hard border”.
Moreover, it said:
“The United Kingdom’s intention is to achieve these objectives to the overall EU-UK relationship. Should this not be possible, the United Kingdom will propose specific solutions to address the unique circumstances of the island of Ireland”.
However, it continued:
“In the absence of agreed solutions, the United Kingdom will maintain … those rules of the Internal Market and the Customs Union which, now or in the future, support North-South cooperation, the all-island economy and the protection of the 1998 Agreement”.
That is absolute nonsense. How can we remain in the single market and the customs union and have an open border? Then, of course, the DUP has said categorically that there will be no border in the Irish Sea. It wants a commitment to preserve the integrity of the United Kingdom and for our internal union to be preserved. How will this be possible?
Theresa May has said that,
“we will maintain the common travel area throughout these islands … the whole of the United Kingdom, including Northern Ireland, will leave the EU customs union and the EU single market. Nothing in the agreement I have reached alters that fundamental fact”.—[Official Report, Commons, 11/12/17; col. 27.]
I just do not see how this is going to happen. At First Minister’s Question Time in December, Nicola Sturgeon stated that if there was a differential for Northern Ireland it should be available to other parts of the UK as well.
This is so worrying a situation, where devolution is threatened. Brexit presents a risk to these overlapping competences. Article has followed article, among them:
“How Brexit has reopened old wounds on both sides of the Irish border”.
If we look at voting by religion, we see that 85% of Catholics supported remain and 40% of Protestants. Overall, the result in Northern Ireland was to remain.
Donald Tusk met Leo Varadkar, the Indian-origin Prime Minister of Ireland, and said:
“Let me say very clearly: if the UK’s offer is unacceptable for Ireland, it will also be unacceptable for the EU. I realise that for some British politicians this may be hard to understand … This is why the key to the UK’s future lies - in some ways - in Dublin”.
One of the most worrying things about this whole issue has been leave voters saying that they were 79% English, not British. What are we doing here? Amartya Sen spoke about identity—we all have multiple identities. As a country, we are a United Kingdom first, then England, then Northern Ireland, then Wales, then Scotland. That is what comes first and this is what we are threatening. We are threatening the European Union’s integrity; we are threatening the United Kingdom’s integrity. Everyone in this debate has said, “When Brexit happens”; Brexit is not a done deal; we still have the option to remain. Times have changed and we have the option to remain and that should be considered, because divided we fall and united we are strong.

Lord Hennessy of Nympsfield: My Lords, I declare my membership of the advisory council of These Islands.
As a remainer and a United Kingdom man to my last fibre, I was fearful in the gap between the Scottish and the EU referendums, as was the noble Lord, Lord McInnes, and other noble Lords, that a vote to leave would reinflame the UK question—that some might argue in Scotland that the vote not to separate in September 2014 largely, if not wholly, turned on economic factors and that the deal was now off, as the UK, thanks to the June 2016 EU referendum result, was set to build a very different kind of political economy for itself. Another referendum on the question of Scotland might therefore be justified if the thrust of this argument carried force.
If such an outcome occurred—as that great political scientist Lady Bracknell might have expressed it—to lose one union may be regarded as a misfortune; to lose both seems like carelessness. I profoundly hope that the union of the UK is not fractured in the future, for it would be a misfortune of the highest order, changing the nature of our country and the very way we imagine it and seriously diminishing thereby our place in the world.
If dealing with the consequences of Brexit turns out, as the wording of today’s Motion hints, to be a successful co-operative effort between the UK central government, this Parliament, the devolved Parliament and Assemblies and their Administrations, it would be a conspicuous enhancer, rather than a diminisher, of the union of the United Kingdom. I dearly hope that that occurs.
But some peril lurks in the devolution clauses of the European Union (Withdrawal) Bill. To my regret, I shall be away from London on one of the days when your Lordships’ House will be debating it at Second Reading, but had I been able to speak this is the area on which I would have concentrated, for here lies a mixture of delicacy and complication. Rereading recently the European Communities Act 1972, I was struck by the contrast with the withdrawal Bill shortly to come before us. Both are what one might call pipeline measures, the first pouring existing Community legislation into our islands on 1 January 1973 and the second repatriating the powers that we have pooled with our European partners since that date.
But in 1972-73, there were no devolved Administrations; they are creations of the late 1990s. If we consult the official history of the UK’s successful entry negotiations penned by that great public servant, the diplomat Sir Con O’Neill, who led the official negotiating team—it is now declassified and makes a fine and fascinating read—we find very little on Scotland, apart from a few pages on fisheries. For example, those two formidable figures of post-war Scottish politics, Jo Grimond and Lord Boothby, were eloquent about the needs of inshore fishermen seeking their harvest in the testing waters of The Minches, the exquisite seas around the northern isles and the fishing grounds within reach of the north-east coast of Scotland.
But it was a different world. Since then, for example, Section 57 of the Scotland Act 1998 bathes the whole devolution settlement in EU compatibility. As the noble and learned Lord, Lord Wallace of Tankerness, noted, as part of the withdrawal process, some 111 functions are in play that contain a devolutionary element, 80 of which are pretty non-contentious, I understand, but the 31 others might be. As we have also heard, a network of joint ministerial committees, with groups of officials supporting them, has been at work on these problems, mindful among other things of the needs of the UK’s own internal market functioning as it should.
But have your Lordships noticed the paucity of coverage of this critical process by the London-based press, certainly compared to the Scottish newspapers? Yet this is a first-order problem in multiple ways. If the process seriously bruises the internal political and institutional relationships of the Queen’s kingdom, that very kingdom, at best, will function more rancorously in the years after Brexit and, in the worst case, it might be rent asunder.
These intra-UK negotiations will test the mettle of our Ministers and officials in Whitehall and throughout the devolved Administrations, and they have my sympathy in the delicate and difficult task in which they are engaged. I would value greatly a report on the work in progress so far when the Minister winds up. May I request also, henceforth, regular updates for your Lordships’ House on the process of those joint ministerial groups? That would be of immense value to us.
The devolution clauses of the withdrawal Bill that we shall soon debate are crucial for the well-being of our people and the proper functioning of our institutions. It would be truly tragic if Brexit mutated into the eventual dissolver of the union that for more than 300 years has turned us into a most extraordinary United Kingdom atop our damp little archipelago in the cold northern seas.

Lord Bruce of Bennachie: My Lords, I join others in thanking the noble Lord, Lord McInnes of Kilwinning, for opening this debate and congratulate him on the way in which he did so, which I think we would all agree was thoughtful and ranged across the issues. In general, while the tenor of the debate has been modest, constructive and reasonable, it has encapsulated some devastating criticisms of what is happening or not happening. It would be remiss of us not to acknowledge that, whatever the tone may suggest.
The noble Lord said that he was driven by his political unionism and his fear for the union as a result of Brexit. He is right to say that, at the moment, the pressure for further independence in Scotland has diminished, but that is not to say that it will not be revived in the long term. As he rightly said, in Northern Ireland and Ireland, the whole situation is so fraught that almost anything is possible. While Members from Northern Ireland have said that that they do not believe that the drift towards a united Ireland is necessarily stronger, who is to say, if we mishandle this, that the mood would not change? Nobody should be in any doubt that the future of the United Kingdom is at risk, and Brexit has demonstrated that.
While the second part of the Motion refers to seizing the opportunity to redefine the union and how it operates, frankly, we should have done that long before we got to Brexit. We have done it in a piecemeal, ad hoc and untidy way. I know that I on these Benches am perhaps a little idealistic in my commitment to federalism, but something like federalism will eventually have to be enshrined in our constitutional arrangement if the union is to hold together.
Speakers have looked at different aspects of devolution for the different, component parts, with the Irish question being the most fraught and the most unclear, and then the Scottish question and the Welsh question. Regardless of how the countries voted, there is a fundamental anger that, in spite of the statement that there is a wish to ensure that the settlement for Brexit carries the whole United Kingdom with it, it is clear that England is carrying the rest in its slipstream and that it is not a partnership of equals or even a partnership—let us be realistic that they are not equal, but there should be a partnership.
I was interested to see the dilemma, from my own point of view in Scotland, of the Scottish Conservative Party, which is fundamentally split in a very obvious way. We had a delegation from the Scottish Parliament in the last few days, including Conservative Members of the Scottish Parliament, seeking clarification on Clause 11 and encouraging the amendment that we are all looking for, which will meet the wishes and aspirations of the devolved components. Yet Conservative Members of the Westminster Parliament from Scotland have lifted not a finger in any way at all to support amendments that would have dealt with Clause 11. So the MSPs are singing from one hymn sheet and MPs, apparently, from a different one. Indeed, with one exception, it seems that all the Scottish Conservative MPs are enthusiastic Brexiteers, in spite of the will of their own constituents, and have followed the votes accordingly.
The leader of the Scottish Conservatives, Ruth Davidson, just in the last few days has pleaded with the Prime Minister to ensure that the Brexit settlement is a settlement for the whole of the United Kingdom that takes full account of Scotland’s interests. But in reality how can that be, when Scotland is quite clear that being part of the single market and being in the customs union is essential for Scotland’s economic future, and the Government have ruled both those things out? These are unscripted exchanges, but, fundamentally, they are incompatible.
In fact, it has dawned on me in the last two weeks that not only are the Government divided absolutely down the middle, with a Cabinet that is so carefully balanced that it encapsulates in equal numbers two utterly irreconcilable positions but, worse than that, the communication from the Government is two-way and, if I may say so, two-faced. They say to people who voted remain, “Don’t you worry—there will be an agreement that fundamentally maintains many or most of, if not all, the benefits that we have enjoyed as a member of the European Union”. At the same time, turning to the Brexiteers, they say, “Be assured, we are leaving the Union and all its institutions—we will not be part of the single market or the customs union”.  At what point does this logjam have to be broken? We have eight months until we have to have an agreement on exactly what kind of exit arrangement we will have negotiated.
We had the noble Baroness, Lady Goldie, in this House earlier this week, for whom I have a lot of respect—and I know that the Scottish people have a lot of affection for her in her role as leader of the Scottish Conservative Party. It hurt me to see her defending a position on financial services, so important to Scotland, on the lines that it would be impossible to deliver the promised statement on the future arrangement for financial services, as this would reveal our negotiating position. My understanding of negotiations is that, while you can negotiate in secret, it is quite important that the people with whom you are negotiating are not included in the secret—that they are, in fact, a party to what your aspirations are and know what you are negotiating for. Until you do that, you actually make no progress. We are deadlocked. It seems to me that we have a few months to come to a conclusion as to what the compromise is going to be.
I mentioned financial services. There is a tendency for people to assume that this means the City of London, but it does not mean that; the City of London is about half of our financial services industry, but there are more than 150,000 jobs in Scotland in financial services, especially in Edinburgh and Glasgow, but also in Aberdeen and elsewhere—Perth, in fact, is an important centre, too. I have served on the EU Financial Affairs Sub-Committee, and we have had consistent and overwhelming evidence, including from Scottish institutions, that without passporting and without an agreement that enables us to participate fully in the single market in comparable terms to the way we do now, thousands of jobs will be lost.
Indeed, JP Morgan has said overnight, in the meeting in Davos that, if there is no agreement to maintain most of our existing arrangements, it will move more than one-quarter of its 16,000 workers out of the UK. Replicate that across the financial services sector and then add it to every other sector that has the same uncertainty and difficulty. We are talking about tens if not hundreds of thousands of jobs at risk, and we have only a few months to come up with an agreement that will resolve the issue.
Currently, the pound is on an upswing. I am told that the markets are of the view that a constructive agreement can be reached, and that is why the pound is strengthening—although some people say that, actually, inflationary pressures and the prospect of an interest rate increase may be the major factor. However that may be, it cannot go on with all these questions about how the interests of Scotland, Wales and Northern Ireland, and indeed those parts of England that voted to be part of the single market and the European Union, can be reconciled with an agreement that maintains or does not maintain the links. How is it possible for our interests to continue outside the single market and the customs union?
The issue of Northern Ireland has been particularly fraught. As the noble Lord, Lord Bilimoria, said, the can has been kicked down the road. My noble friend Lady Smith mentioned alignment, which is absolutely  crucial. The Government are basically saying that everything will change and nothing will change. The border will be open, there will be no border, but we will not be inside the institutions that protect themselves by a border. It is not our decision. Indeed, the Government will say that if there is a border in Northern Ireland it will not be our fault; it will be because the EU impose it, but the EU will impose it only because we do not have an agreement that enables the border to be open.
I suggest to the Government that the letter has to go beyond to the spirit. They should listen to the devolved Governments and institutions, because it is impossible to deliver a settlement for the whole of the United Kingdom that does not take account of the wishes of Northern Ireland, Wales, Scotland and the regions of England. I agree that the Scottish Government’s plea for some kind of separate deal for Scotland to be in the single market and not the rest of the United Kingdom is preposterous, absurd and undeliverable. Indeed, as my noble and learned friend Lord Wallace said, the United Kingdom single market is far more important to Scotland than the EU single market. But they are both important and both need to be reconciled, and time is running out for the Government to go on facing both ways, keeping the negotiations secret and offering no end-point. We have to resolve this dilemma, or not only is the UK’s economic future at risk but the integrity of the United Kingdom is under threat. The Government should not underestimate that.

Lord McAvoy: My Lords, I join those who have thanked the noble Lord, Lord McInnes, for securing today’s debate. He has done a service to the House. My party and I are firm supporters of the union and wish to see it strengthened throughout all the challenges and opportunities that Brexit may bring. We are a union by consent, and powers have been devolved across the UK following votes, referenda, general elections, debates and Acts of Parliament. Our unique devolution settlements enhance and underpin this union of ours.
Towards the end of last year, this House had the opportunity to debate a number of excellent reports from the Constitution Committee on devolution, including its relationship to the relatively new context of Brexit. We debated issues including the lack of a government blueprint for working with the devolved institutions; the poor use of existing structures, including the JMC, which at that point had not been convened for nine months; and, as the noble and right reverend Lord, Lord Eames, so eloquently illustrated, the lack of full democratic representation for Northern Ireland. We have called many times for a unique demonstration of how important the UK Government regard the situation in Northern Ireland as being but, unfortunately, to no avail. Unfortunately, a few months further on, we must revisit some of the same issues, particularly with regard to Northern Ireland.
As of this month, it has been a full year since Northern Ireland had a functioning, power-sharing Executive in place. This must give us all pause for thought. We welcome the new Secretary of State to her post, and  wish her well in her endeavours. But what we cannot have, surely, after 12 months of no movement and failed talks, is more of the same. The Government are telling us that one last push is all we have time for. We welcome the new talks that began yesterday and hope that all parties will engage in them as fully as possible. We have put on record our belief that the Secretary of State must involve all parties, including the smaller parties, in the talks, and that she should consider the appointment of an independent chair.
Noble Lords are aware that uniquely Northern Irish issues around the border and protection of the Good Friday agreement are at the heart of the Brexit process, yet there is no democratically elected Executive representing the people of Northern Ireland in these talks. These issues are also being dealt with at a time when there is no nationalist representation in either House of Parliament. As we look to the future of the UK outside the European Union, we cannot stress enough the importance of the Prime Minister and her Government engaging wholeheartedly on securing the future of Northern Ireland.
Beyond the pressing issue of Northern Ireland, the Government must concentrate on both their current and future relationship with the devolved institutions. It is not enough to firefight or untangle each individual issue as it arises; there must be a mode of working that allows the devolved Administrations consistently and co-operatively to feed into the Brexit process. Early signals from the Government have not been encouraging. Last year we had the JMC not being called from February to October; this year we have the EU (Withdrawal) Bill which has been described by Members on all Benches in this House as not being fit for purpose on devolution. It is ludicrous and inaccurate to use such descriptions as “a power grab”; nevertheless, the vacuum being created by the Government not responding positively to the devolution principles is creating an atmosphere in which that accusation can be made and can gain credibility.
The House will be all too aware that the Scottish and Welsh Governments have warned that the Bill, as currently drafted, is in danger of not receiving legislative consent. Government Ministers have accepted that their own Bill is in need of amendment. They have promised that amendments on devolved powers will be brought forward in this House, after they failed to table them during the Bill’s stages in the House of Commons. Perhaps they will take inspiration—I hope they will—from amendments tabled by Her Majesty’s Opposition in the other place, which would have removed proposed restrictions on the devolved Administrations and allowed for the collaborative creation of common UK-wide frameworks for retained EU law. The question is how these flawed proposals were put before this Parliament without meaningful discussion first taking place with the devolved institutions. The Government must surely be aware of the lack of faith in the devolved institutions that the Government are taking their concerns seriously. I would like the Minister to illustrate what steps the Government are taking to assure the devolved Administrations that their genuine concerns are being listened to.
The mistakes should not be repeated. We have had some encouraging developments in the JMC on principles  to allow common frameworks, which are key to the future of the UK economy. It is a small step, but surely is the start of something to be developed along these lines. Looking to the future, I ask the Minister: what is the next step in the establishment of those common frameworks that the UK as a whole needs to thrive? How will they be consulted on, agreed and, if necessary, legislated for? What are the Government doing to build the necessary machinery of government, to ensure that intergovernmental relationships are strengthened, that simple, everyday co-operation is facilitated, and that departments across Governments are working well together? What is being done to bolster expertise in devolved issues in the Civil Service? Different departments currently work with the devolved institutions to differing degrees and with differing amounts of success. Brexit will be a success only if it works for communities, businesses and people in every corner of the United Kingdom. We must ensure that detailed understanding and expertise about issues specific to Scotland, Wales and Northern Ireland is widespread among the departments delivering Brexit.
This is a new challenge but also an opportunity for our union, and the Government must rise to it. The Government must proceed in a way that strengthens our union, respects devolution and provides the devolved Administrations with a clear voice moving forward. My final word—I appreciate that the Minister has a lot to answer so I will try to give him some more time for that—is that the Government must take on the perception that no one has a firm handle on the Brexit negotiations with the European Union. They have created the perception that they do not have a firm grip on how to handle negotiations and understandings and get co-operation from the devolved Administrations. For the sake of all our people, we wish the Government well, but they really need to start demonstrating that they have a firm grip on these proceedings.

Lord Duncan of Springbank: My Lords, I thank the noble Lord, Lord McAvoy, for his generous donation of further time to allow me to answer all these questions. I also congratulate him, of course, on his elevation to Chief Whip. I look forward to hearing much more from him in that capacity.
There are, I suspect, a number of challenges that lie ahead for all of us in trying to grapple with the issues we have touched upon today. A number of noble Lords have reflected today upon the fact that our union is an extraordinary thing and in many respects we sometimes take it for granted. Indeed, all too recently it almost slipped through our fingers. Yet here we are now. We often talk about our constitution, both written—in several documents—and of course unwritten, but in fact, from 1979 through to 1997 and beyond, the sheer volume of change, evolution and, indeed, in some cases near revolution in the way we administer power within the United Kingdom was fundamental. It is important to recognise, again, how flexible our system can be to allow that sort of change to happen without there being a great deal more angst and unease.
I begin by delving straight in to the question of the repeal Bill, since many noble Lords touched upon it. Clause 11 needs to be amended: it is not going to work in its present form. The important thing to stress is that it was not for want of effort on our part—the noble and learned Lord, Lord Hope, was quite correct—to secure a form of words that would allow the two devolved Administrations and the UK Government to reach a consensus on that point. The key thing, and this is why I stress the point, is that this is part of the respect agenda: we must find a form of words with the devolved Administrations to secure progress going forward. As all have noted and accepted, if we do not secure that form of words, the legislative consent motion we will need will not be made available. Then, a constitutional crisis, to use that slightly hackneyed phrase, will be upon us. That is why every effort is being made to ensure that we can find that form of words with the Ministers from Scotland and Wales—always recognising that we are also reliant upon the civil servants in Northern Ireland—who must give us guidance on how we are going to take this matter forward. I wish I could tell noble Lords right now that we have that form of words: I cannot, but I know that discussions are ongoing and all are aware that the time for those words to be agreed is slipping gently away. I believe that on all sides there is now a recognition that we must secure these words if we are to make the progress we would like to make.
The wider question has been asked about the common frameworks and the nature of the laws, and how they will move and migrate. Is work going on to establish exactly what the common frameworks will look like and whether there will be clarity? I assure noble Lords that that is indeed happening. It is being done under the slightly euphemistic term, “the deep dive”: in each of the policy areas a deep dive involves all those involved in the devolved Administrations—Wales, Northern Ireland and Scotland—as well as the UK Government.
The purpose of those deep dives is to identify exactly the areas where there is no need for a common framework—indeed, those roles would then be fully devolved—recognising which ones must one must remain fully reserved and teasing out the complexities in the middle ground. The noble Lord, Lord Lang, mentioned that very point. This is where it becomes a little bit more complicated, but it can be resolved; that is the purpose of the deep dives. Take, for example, a subject that is very dear to my own heart and to a number of noble Lords here today: fishing. At present, fishing is wholly devolved—there is no way round that; it is a clear statement of fact—but it is devolved within the framework established by the common fisheries policy. At present, every aspect of fisheries is broadly administered by the Scottish Government, on the basis of the established framework. Going forward, the question is, what should replace that framework? In many instances, the answer is that there need not be a common framework and these matters will be fully devolved. For example, issues around what I would term technical measures, such as the mesh size of nets, will continue to be taken forward by the Scottish Government in exactly the same manner as now.
Let me revert to other, perhaps broader questions about quotas and quota management. Here, different questions must be resolved. That is the purpose of the deep dive: not to tell the devolved Administrations what the answer or the UK Government position is, but to ask what will work best for our fishermen up and down the land. No fisherman fishes simply on their own little bit. We have a much more mobile fleet; the distant water fleet fishes all across our territorial waters, as well as those of other countries, including Norway and EU countries. We need to find a way to make that work. That is why, in this instance, oddly enough, the term “deep dive” is probably appropriate. We need to find a way to make sure that we can deliver on that.
Deep dives will take place across all policy areas. In the lead, necessarily, are those that are closely connected to Defra and focus on fisheries, agriculture and the environment. However, a number of others are happening as well—though not quite in lock-step—to secure answers, because these are the key points that will allow the devolved Administrations to have confidence that we have taken their concerns on board and intend to move this forward in a manner that respects both sides.

Lord McConnell of Glenscorrodale: On that specific point, we all understand that there is complexity in these policy areas and that there is a difference between the administration of policy and the agreement, implementation and legislation of that policy, whether it be in fishing quotas or anything else. Do the UK Government understand that the key point of principle is not whether there should be a common framework but whether one should be imposed from the centre—or whether the agreement to have a common framework and commit to it should be voluntary on the part of the three devolved Governments and the UK Government representing England?

Lord Duncan of Springbank: I thank the noble Lord, Lord McConnell, very much for his intervention. The respect agenda is at the heart of the answer to that question. The deep dives are vital for each of the participants to recognise that the solution needs a common framework to address the particular challenges. There will be tensions—I do not doubt they will exist—where there is disagreement, where one of the Administrations say, “Actually, in this particular area, we believe this and the other one disagrees with it”.
Part of the bigger challenge is the movement of rules coming back from the EU, where there are—as the noble and learned Lord, Lord Wallace of Tankerness, pointed out—111 laws that directly affect Scotland. For Northern Ireland, it is over 140; for Wales, it is around 60. Of course, because of the devolved settlements, the rules are different; so again, the point is to try to find areas of common consensus. In truth, representatives of the various individuals who are part of the stakeholder community will each have to be able to defend their points to the stakeholders, to explain to them why they are arguing one way or another. Those stakeholder communities must also lend their acceptance to this particular point, because upon the hearing the outcome  of these discussions, they cannot—and should not—rise up in arms and say that it is an absolute travesty and a scandal. They should be satisfied that this is the best and right way of doing things. The important thing to emphasise is that this is not in any way an attempt by the UK Government to demand certain concessions from the devolved Administrations. That is not the ambition at all.
On the wider question of the institutional arrangements whereby the various parties come together and meet, there have been challenges. There is no point in pretending otherwise. I have a very helpful list somewhere. Noble Lords have asked very thorough questions so I have many pieces of paper; I am now hunting for the right one. We had a hiatus between February and October 2017 for one particular reason: the election. That slowed things down quite considerably. The important thing to stress is that for a very long period, the JMC’s arrangement had been all but moribund: it had not been a functional part of the engagement between the devolved Administrations and the UK Government. Recognising that that was no longer fit for purpose, the UK Government have sought to expand the number of forums by which we have agreement under the JMC, as well as recognising that the frequency of those must therefore be driven by the necessity of the particular issues. That is why what would have been the traditional ongoing European legislation—which was the most important forum for the focused issues before the devolved Administrations—is, if anything, the quieter forum. The negotiations forum is now absolutely critical, as is trying to make sure that there are opportunities at those meetings for a free and frank discussion. There are, and I can assure noble Lords that the discussions are very free and very frank.
There are challenges. I am reminded of the words of the noble Lord, Lord Bruce of Bennachie. At the outset, one of the challenges in this area was that it was very hard to reconcile the demands of the different Administrations because they were not bridgeable in simple terms. So, the notion and the paper put forward by the Scottish Government could not be easily reconciled with the reality of what the UK Government believed they had to deliver after the referendum. That caused a lot of the political tensions. It is very hard to meet on common ground when one party is on one side of the chasm and one is on the other; you end up falling to the bottom like Wiley Coyote, with your arms flailing in the air. We were trying to avoid that outcome. It is bridge building that gets us across the chasm, I hope.
We need to give some consideration to the situation in Northern Ireland. Many noble Lords have rightly mentioned that there is a void in Northern Ireland. We cannot pretend otherwise. I can assure noble Lords that my right honourable friend the Secretary of State for Northern Ireland is actively pursuing facilitating the dialogue required to develop a functioning Executive. On more than one occasion, I have said from this Dispatch Box that Northern Ireland is ill-served without an Executive. Although the civil service there can do a great deal to help in many different areas, they cannot do everything. That is why it is important to recognise again the need for a realistic and functional dialogue.  Those talks are ongoing; we hope that those around the table will recognise the importance of securing agreement on this occasion but we recognise the challenges that we face.
On the question—again, raised by a number of noble Lords—of the agreement reached by the UK Government and the EU before Christmas, which touched on Northern Ireland and the border question, it is important to recognise that that is but one step toward a larger agreement between the UK and Northern Ireland. Without that agreement, there will be significant challenges for both sides. That is why, in this instance, the ongoing negotiations again seek to address the challenges. One would hope that through that, the negotiations will deliver the Northern Ireland question as part of a bigger settlement. Those negotiations are ongoing. I believe—this is where it becomes important—that we often find ourselves, particularly when following certain newspapers, caught up in an almost daily crisis of one sort or another, with the narrative driven forward in that fashion. However, if we step back and think about it, just before Christmas the UK Government managed to deliver on what they said they wished to do: secure agreement on these three key areas, to allow negotiations to begin shortly thereafter. They achieved that. From some of the reporting, you would have thought that they had failed, but they did not. They moved things forward in that fashion.
The time ahead will not be straightforward. I realise that we will have plenty of opportunities to discuss further the questions that underlie the repeal Bill. I am sure that many of the contributions made today will help inform the Government as they begin to think about how best to approach the investigations into the repeal Bill and its functionality. But we will have to resolve those questions here in such a fashion that we can return those amended clauses to the House of Commons to allow them to deliver upon that. I believe that we will make a difference and, indeed, do what this House always does: seek to make things better. I think the Government will appreciate the work done here in that area.
We have to recognise that the union is perhaps something larger than just the moment of Brexit and the discussions that surround it. A number of noble Lords have pointed out today that immediately after the referendum on Brexit, there was a great fear that our union would itself begin to experience some of the challenges but in truth, there has been a degree of resilience. As we witnessed through the, shall we say, unexpected general election last year, the parties that had perhaps anticipated doing better, certainly in Scotland, did not do so on the basis of what they offered the people. That should be a salutary reminder to anybody who believes that they have the people behind them: it is always worth looking over your shoulder, just to make sure they are still there. You cannot take the people for granted in this regard. The result of that election was a useful reminder to us all to focus on what the people want, whether that be the people of Scotland, the people of Wales or, I hope soon, the people of Northern Ireland.
We in this House must recognise that we have a role to play in ensuring that our union works, and works well. That is why I am indebted to my noble friend  Lord McInnes for bringing before us today an opportunity to discuss and explore these issues. It is timely because next week, we will be knee deep in thorough discussions on the questions before us regarding repeal. As I try to answer the questions, I am aware how useful that will be to my colleagues in facilitating, I hope, the right sort of dialogue as we go forward. But I am also aware that there is heavy lifting to be done and we have not yet resolved these issues. On the question of Clause 11 as it affects the devolution settlement, we need to be able to bring before your Lordships a workable amendment that can deliver exactly what it says on the tin—and when we tell your Lordships that we have it, we are telling you that other people in Edinburgh, Wales and, through consultation, Northern Ireland agree that this is the way forward. That should allow us to make that necessary step.
When I began my remarks, I pointed out that in some respects we have been through a revolution, as only Britain can do, in the way that our powers have moved. But we have done so in a piecemeal fashion; again, a number of noble Lords made this point. We need now to refocus on trying to ensure that we are not making stumbling progress but have a clear objective: to make sure that the devolved Administrations fit into a sensible and workable government structure for the United Kingdom. People have to recognise that whether they are in Edinburgh, Wales or Northern Ireland, they have two Governments, not just one. It is important to stress that. Again, we need to be better at explaining to people what the Governments are doing and what their actual responsibilities are. Quite often there is sheer confusion on these points.

Lord Wallace of Tankerness: I generally agree with the point the Minister is making but, as part of that better integration, will he respond to the suggestion I made, based on the Canadian experience, that Northern Ireland officials and Scottish and Welsh Ministers might also be involved at the table in the forthcoming phase 2 negotiations?

Lord Duncan of Springbank: The noble and learned Lord, Lord Wallace, makes an important point. As a Member of the European Parliament many years ago—no, last year; time is just slipping through my fingers here—I am very conscious that the discussion was always about who sits at the top table and therefore represents the United Kingdom. I was always of the view that the table in London, where all the devolved Administrations argued these things through, was as important as the seat at that top table. Determining the UK position in this instance will be exactly the same. We must deliver a UK position which is part of the respect agenda and delivers for the peoples of Scotland, Wales and Northern Ireland that which is right, workable and appropriate. I can assure your Lordships that those will be dingdong discussions around the tables in London, where the heaviest lifting will be done. As to the point the noble and learned Lord makes, to be frank I do not know the answer, but the important table is the one where we bring together all these individuals to make sure that we are positioned to deliver on behalf of the people we represent.
I am conscious, again, that I am perhaps overstaying my welcome. On this day of Robert Burns, we are conscious that we celebrate that across the globe. So perhaps I might close with some words of Burns, which I thought were slightly appropriate:
“O let us not, like snarling curs,
In wrangling be divided,
Till, slap! come in an unco loun,
And wi' a rung decide it!
Be Britain still to Britain true,
Amang ourselves united;
For never but by British hands
Maun British wrangs be righted!”.

Lord McInnes of Kilwinning: My Lords, I take this opportunity to thank all noble Lords who have contributed to this debate. I cannot do your Lordships justice by running through them individually in the time I am given, but this debate really has achieved what I set out for it to do. That was, first, as the noble Lord, Lord Kerr of Kinlochard, made clear, to say that perception is so important. After today’s debate, there will be a clear perception that your Lordships desperately want to see a successful settlement of the Clause 11 issue to the satisfaction of everyone involved, especially the devolved Administrations. The other clear conclusion from today is the feeling in your Lordships’ House that there needs to be urgent action and that absolutely everything needs to be done to ensure that we once again see a proper power-sharing Executive and democratic forum in Northern Ireland. We must have that to ensure not only that Brexit concludes successfully, but for the sake of our United Kingdom. I am very grateful to the Minister for the reassurances he has been able to give us on the importance of joint working and the transparency required to ensure confidence in the process. I once again thank everyone who has contributed to the debate.
Motion agreed.

NHS and Social Care: Winter Service Delivery
 - Motion to Take Note

Moved by Baroness Wheeler
That this House takes note of the impact on front-line social care of Her Majesty’s Government’s NHS plans and the delivery of services over the winter period.

Baroness Wheeler: My Lords, the most appropriate place to start this debate is with the WhatsApp open letter of 12 January to the Prime Minister from the heads of 68 accident and emergency departments in England. Its signatories included St Thomas’s in London, Heartlands in Birmingham, Addenbrooke’s in Cambridge, the Royal Liverpool, and Frimley Park, where Mrs May issued her new year apology for cancelling 55,000 non-elective surgical operations. With figures showing over 300,000 patients waiting more than four hours in A&E, a record half a million-plus  emergency admissions, and 75,000 patients waiting more than 30 minutes in the back of an ambulance, these front-line doctors wrote about the hundreds of patients a day, some of whom were dying prematurely, being treated on corridors and about patients sleeping in clinics turned into stopgap wards.
One of the main purposes of the messaging was to swap practical tips about how to become “corridor specialists” as hospitals become overwhelmed with patients. This speciality includes the Red Cross delivering tea and blankets and sitting with patients waiting on their own. I can think of nothing worse than, for example, being a sick, elderly patient on a trolley without a carer or friend to stay with them, speak up for them or make sure they are being looked after. For the A&E doctors, their reality was that the Government’s winter plans,
“have failed to deliver anywhere near what was needed”.
Their key demand was more hospital beds and an urgent boost to social care. The president of the Royal College of Emergency Medicine warned:
“Our emergency departments are not just under pressure, but in a state of emergency”.
All this, of course, has a huge knock-on effect on social care while arising from the Government’s failure to fund and provide the everyday healthcare and community support, for millions of people who need it, which could stop many of them turning up at A&E and occupying hospital beds in the first place.
We know that the Minister’s response will be his repeated mantra about the extra £337 million the Government made available to trusts this winter and the £1 billion extra in social care funding allocated in the 2017 March Budget. Of course extra funds are welcome but, first, trusts were not told about their allocations until a few days before Christmas, so effective on-the-ground advanced planning was severely hindered as they had no idea of what money there was to spend. Secondly, the Government’s instruction was for half of the £337 million to be spent on servicing trust debts, not on emergency planning. Thirdly, such debts will be further increased by the cancellation of 55,000 non-elective surgical operations. Finally, as all the health think tanks, specialists and everyone involved in the provision and delivery NHS and social care services have attested, the extra funding was simply nowhere near enough even to begin to redress the huge cuts that have been made in NHS funding and local government funding of social care over the past eight years.
The Government need to acknowledge and own up to the scale of the crisis. The Minister knows that the Budget did not provide extra funding for social care in the short term or address the predicted funding gap of £2.3 billion by 2020. Specifically on A&E care, can the Minister tell the House how the Government will assess the actual impact that providing additional funding in November and December had in dealing with the worst winter crisis the NHS has faced in decades?
On social care, as the very comprehensive Lords Library brief for today points out, we talk of adult social care mainly in terms of the needs of older people, but it also includes care and support provided  to physically disabled people, people with learning disabilities, people with mental health problems, drug and alcohol misusers and the carers involved in caring for them. That is the scale of the demand and the need that has to be addressed. I will focus today on carers and older people.
I am a carer, as many noble Lords will know. Emergency care, hospital admission and then discharge is a make-or-break time for carers and their families. Many people become carers for the first time when this happens, as I did. It heaps pressure on families and, despite all the guidelines, most discharges take place with little notice, particularly when there is a national directive to free beds to make way for winter. If you speak to carers, particularly if discharge takes place when the patient is medically unfit or without the proper facilities and care available at home, they will tell you that this is one of the most traumatic times for them.
The number of carers is increasing every day. It is now estimated at 6.8 million, an increase of 1 million over the past 15 years. As Carers UK has stressed, families are caring more, not less, as some would have it. On top of this, we see in the press that carers have been asked by one trust to collect their elderly from hospital to help with the discharge process and ease the winter crisis. Is this really where society wants to head?
For carers, frequent GP and hospital visits, providing and arranging transport and so on are a routine part of looking after partners or relatives with disabilities or co-morbidities or of caring for frail and elderly people. Cancelled operations mean desperately trying to reinstate the cancellations in domiciliary care support made for the hospital stay and, of course, dealing with huge upset and disappointment.
There is the added winter threat of norovirus or flu and the impact this will have on carer and cared for or on both together. Where there is a carer involved in A&E corridor waits, they will be there with their loved ones, doing their best to care for them in very difficult circumstances and sharing their anxiety and concern. Acknowledging the vital role carers play as partners in the health and social care system has to be backed up by providing the resources that are needed to undertake the caring role.
Can the Minister update the House on the call to action that the Government have promised in place of the national carers strategy refresh that carers were expecting two years ago? It was due in the new year and we are nearly at the end of January. Can he tell us when it is to be published and ensure that it provides the support and resources that carers need?
As Labour has emphasised, the winter crisis has consequences not only for those in urgent need, but for everyone using the NHS. The panic cancellations of elective operations and outpatients clinics in the face of hospitals running at full capacity will have a major impact on the many older people who rely on NHS services to stay well and on their carers. As Age UK has stressed, waiting for a hip or cataract operation or having an appointment postponed will leave many people experiencing pain, discomfort and anxiety. It will result in a need for more support in the home or  from primary care and could even accelerate people’s need for urgent and emergency care.
The noble Baroness, Lady Campbell, wanted to participate in this debate today, but had a previous commitment. She asked me to raise the key issue of the impact that the winter crisis has on people with acute, long-term conditions and disabilities, such as muscular dystrophy, cystic fibrosis or acute asthma, who, if they go down with flu or chest infections, need emergency care in specialised respiratory units. The availability of these beds is increasingly under pressure because hospitals are unable to discharge severely disabled people occupying those beds back into the community if they require more social care support than they had before. She faced this very perilous situation three years ago when her local specialist unit was full to the brim for many days and a suitable, high-dependency placement could not be found, and she lives in fear of that every winter. Will the Minister undertake to write to her on the urgent measures and steps that will be taken to ensure that people with acute and long-term disabilities receive the integrated and joined-up care they need?
Planning for winter means planning across health and social care. As NHS Providers said last year:
“Too often winter pressures has just been about acute hospital capacity. Last winter showed that ambulance, community and mental health capacity are just as important, as is primary and social care capacity”.
Social care’s extra £1 billion pounds last year was designed to reduce delayed transfers of care and free beds, but only 28% of trusts managed to secure any commitment from hard-pressed local authorities to spend the money on delayed transfers. Most would have simply been unable to meet that commitment.
Over last winter the lack of capacity to deal with expected demand across the whole system was clear: 64% of trusts lacked ambulance capacity; 71% lacked acute capacity; 76% lacked community capacity; 80% lacked mental health capacity; 91% lacked social care capacity; and 92% lacked primary care. Can the Minister explain why the Government’s winter crisis plan for this year did not take account of all these factors? Was this really the effective planning the Government insist went on? Will the lessons be learned for this year’s promised winter crisis ministerial review?
On delayed transfers we know that the NHS needs to get its act together. More than 58% of delayed transfers in November 2017 were attributable to the NHS, mainly through patients having to wait for further NHS non-acute care; 34% of delayed transfers were due to social care. What was the main reason? It was patients awaiting a care package in their own home. Financial penalties on local authorities or instructions to trusts to use the limited extra funding to reduce their debts do not address the crisis in either sector. As the Local Government Association puts it, delayed transfers,
“are a symptom, not the cause, of the pressures on the NHS and in many cases the solutions will lie in investment in prevention, primary care, community services and hospital avoidance schemes ... There cannot be a sustainable NHS without a sustainable adult social care system”.
We know that as a result of the cuts to local government, the availability of adult social care packages has fallen so dramatically that 90% of councils are now able to respond only to people with critical and substantial needs. At least 400,000 fewer people are getting publicly funded help. Age UK’s estimate is that there are now 1.2 million people with unmet needs for help with essential daily support, such as bathing, toileting, taking medicine, cooking, shopping and other everyday tasks.
All this makes it vital that the Government’s Green Paper this summer does not deal just with a cap in care costs or any disastrous proposal for a care cap floor, unless, of course, Jeremy Hunt throws in the towel and recognises that the Dilnot proposals that we all spent two years working on are actually the best chance we have for bringing fairness and some equity into the health and social care system in the near future. The Green Paper must also address how we can achieve the fundamental integration between health and social care that is needed to meet the scale of the current crisis and the rising demand and to provide the care and support that people should be getting.
The Government have tried very hard to make the change of Jeremy Hunt’s title to Secretary of State for Health and Social Care sound like a fresh and important sign of action and purpose. I must say that I am one of those who thought he was supposed to have that role anyway. However, if it means that the Green Paper will be health and social care-led—rather than led by the Cabinet Office—and that Jeremy Hunt will take leadership responsibility instead of, as is his frequent habit, blaming the health and social care crisis on everybody else, then that is at least a start. His recent recognition of the need for a 10-year strategy is also a step in the right direction.
Can the Minister confirm that the Green Paper is still scheduled for the summer? Can he be any more specific about its aims, scope and publication date? What work will be done alongside the Green Paper to produce a national integrated staff recruitment, training and development strategy for health and social care? Currently, Health Education England provides the NHS staff strategy and Skills for Care deals with social care staff. Is this not a key issue that needs to be addressed to ensure integrated working? Will the chronic low pay problems, particularly in social care, that are one of the root causes of staff shortages and low morale be tackled? How will health and social care budgets be joined up?
I am grateful that this debate has attracted so many experts among noble Lords, and I am very much looking forward to it. I close by paying tribute, on behalf of us all, to the extraordinary efforts and work of our NHS and social care staff, particularly over this Christmas and new year and this winter.

Baroness Pitkeathley: My Lords, I have lost count of how many debates on these and related topics I have taken part in during 20 years in your Lordships’ House, but that does not make me any less enthusiastic about taking part in this one or make me  offer any fewer congratulations to my noble friend on securing it when both the topics and the timing are of the utmost importance.
I might shock your Lordships today if I stand here and say that there is no winter crisis in the NHS and that there are no problems in the NHS. But in one sense, many would say that is right. The cancelled operations, the ambulances queuing, patients dying in corridors and all the rest are actually a crisis of social care, not of the health service. Health service budgets may be ring-fenced, but social care has lost about £6 billion from its total spend, and a 50% rise in the number of especially elderly people stuck in hospital is because there is nowhere for them to go in the community. Nearly 1,000 care homes have closed and 30,000 care home places have been lost because the providers can no longer afford to operate on the money they receive from the state, especially in areas where there are fewer wealthier self-funders, who cross-subsidise the places which are paid for by the state. By the way, this is another scandal waiting to happen, as it is in effect a stealth tax.
The last time that I spoke on social care I said that I was beginning to see a bit of light at the end of this long, dark tunnel, as there seemed to be some kind of consensus, at last, about the fact that this issue had to be tackled, even if there is no consensus as to how. Since then, we have seen the Secretary of State for Health add social care to his title, which I acknowledge is a step forward, even though there has been no change in how the budget works, with the purse strings for social care still apparently held at the DCLG. The result is the chaos we have seen all too frequently.
I am sure the Minister will tell the House about areas where pooled budgets are working well. I applaud those, but let us not forget that the reason we are seeing the growth of things like accountable care strategies and strategic partnerships is that local people are having to find ways to work around the fragmented system that was set up with the disastrous reforms of the Health and Social Care Act 2012, under which nobody knows who is in charge and decision-making is complex and fragmented.
Of course, what anyone who has been in A&E this winter will tell you are tales not only of chaos and pressure but of the hard work and commitment of dedicated staff doing their best against the odds. Another lot of people doing their best against the odds are the carers, already mentioned by my noble friend—who brings such valuable experience of her own as a carer to your Lordships’ House.
We must never forget the contribution of carers to social care, which is worth £132 billion every year, but neither must we forget the cost to the carers themselves. Three-quarters of carers report that their own health—physical or mental, and mostly both—is adversely affected by their caring responsibilities, while the financial strain of caring is well documented: not just the immediate costs of extra heating, transport and specialist food but the loss of future income because of lost earnings and lost pension provision. We should also remember that many people in the health and care workforce, struggling as they are to cope at present, are also juggling that work with their caring responsibilities.  How are they supposed to make arrangements when they are given no notice of hospital discharges and given no choice at all about providing care for a loved one?
However, not involving carers is short-sighted and makes neither economic nor moral sense. That is why the failure to produce the long-promised carers’ strategy has been a great disappointment and disillusionment to the carer population—two years, we have waited for it. Of course the Minister will say their needs are to be included in the Green Paper on social care, but, as my noble friend asked, where is the action plan that was promised as a stop-gap? What will it cover? How will it be implemented? When may we expect to see it? We need urgent answers, and I hope today we are not going to be fobbed off with, “It will appear in due course”, which seems to be the Government’s answer to everything at present.
The Secretary of State is now in charge of the promised Green Paper and we simply must hope that he will find a way to rectify the decades of debate followed by inaction that we have had on social care. Heaven knows, debate has not been lacking: royal commissions, Wanless, Barker, Dilnot—your Lordships will be familiar with them all. But they have been followed by indecision upon indecision about how we are to tackle the complete unpredictability of the cost of care for families. It is literally a lottery where some of us pray we will die of cancer, and therefore get our care funded by the NHS, and not of Alzheimer’s, when we or our families will have to bear the burden. The only fair solution is to pool the risk between as great a number of people as possible so that everyone loses something but no one loses everything.
Of course, how social care is to be funded in future is a political decision, and surely if this winter has shown us anything, it is that such decisions cannot be put off and kicked into the long grass as successive Governments have done for 30 years. Is a consensus emerging, for example about a hypothecated tax? The chair of the Health Select Committee believes that national insurance could be extended to those over retiring age. Could some of us better-off pensioners—I include many in your Lordships’ House in that—forgo our £200 Christmas bonus and our free prescriptions? I know there are anxieties in all parties on this topic. My own party worries about the charges of a “death tax” that were made about our proposals in 2010, and no doubt the Government are still bruised by accusations about a “dementia tax” made at the time of the last election. But with the numbers of people over 85 set to double by 2039, there is no more pressing problem that our nation faces—even Brexit, although that will bring its own problems.
The snowdrops are out, the weather is milder and the winter crisis may be receding, but the respite is only temporary. Let us not have this self-same debate next January. We need political courage and leadership, and now is the time to show it.

Baroness Barker: My Lords, I thank the noble Baroness, Lady Wheeler, for the opportunity, as the noble Baroness, Lady Pitkeathley, just said, to return  again to this subject. I will not make a long speech as I would like to leave as much time as possible for the debate that will follow. On behalf of my colleagues on these Benches, I wish the noble Baroness, Lady Jowell, all the very best and ask her colleagues to convey that to her.
The noble Baroness, Lady Pitkeathley, is right: we have been back to this ground so many times. In preparing for this debate, I thought back to many of the debates that we have had in the past. The origins of the problem we are looking at go back to the National Health Service and Community Care Act 1990. In that Act, for the very first time, welcome things happened: we began to break down procedures within the NHS and to cost and quantify them. But the problem was that we made them into individual units of activity, and to this day, within the NHS, the systems that join up those individual units are failing. They fail completely when they have to be matched up with the social care system, which is completely different.
Those problems were identified and partially addressed in 2003 with the Community Care (Delayed Discharges etc.) Act, when the then Minister, the noble Lord, Lord Hunt of Kings Heath, was sitting there trying to answer questions from very talented opposition spokespeople such as me. We asked him a question that he never could answer, which was why the then Government thought that the answer to the problems in the NHS was to fine social services departments. I never understood that. We still have, within the whole system of discharge, a system of penalties.

Lord Hunt of Kings Heath: Perhaps I can answer the noble Baroness. Surely the point is that both local government and the NHS were being properly funded at that point. Therefore it was entirely appropriate to have a system to encourage local authorities to do the right thing.

Baroness Barker: The issue that I think the Government were trying to solve was one for which we have never had any evidence: that of local authorities trying to game the system. It is correct that the overall amount of funding has gone down, but we have not had evidence of people gaming the system.
We have never had a system, or even part of a system, that incentivises GPs and those in charge of social care to prepare for winter pressures, invest in programmes that will see older people through the increased incidence of illness that we know happens in winter, and avoid unnecessary admissions to A&E. What has changed in that time is that we now have better data and better information systems, but in many ways we are still failing to take all that and improve those systems. At the moment we still have ambulance services being rated on completely different systems across the country so we cannot generate data.
The Government have done some things that are very welcome. Everyone agrees that the primary care streaming system, into which they put £100 million, is a worthwhile initiative. Unfortunately, the initial evidence is that it is failing simply because it takes people from another part of the system—GPs—and locates them  in hospital. What are the Government going to do to properly monitor that system in its entirety as part of an overall approach to winter pressures, to see whether it is worth more investment or whether it simply takes resources from other parts of the system?
On the question of beds, we have a national system of monitoring general and acute beds and ways of measuring the overall occupancy rate. We do not have a method of assessing the number of beds in relation to need. For example, we can open up a load more beds, as the NHS always does at times of crisis, but if there are no more staff to look after the people in those beds then we are not really addressing the need. We need to refine the measurement of this so that we have a metric along the lines of “nurses per bed per day”. That is the point at which things become really bad. I remember talking to a nurse about a patient—actually my mother—and being told that she was far too good to be in hospital and would be going home. She died two days later, which was not a surprise to any of us. I say that because it is not an uncommon experience for patients.
We have been through this time and again. The one thing that we have failed to do is incentivise GPs to work with community organisations from the summer onwards to predict the people in their area who are going to be most at risk and to put in place very low-level, simple and low-cost packages of care for them that can be there very quickly when they are discharged. The biggest cause of delayed discharge is not the absence of social care but the absence of community nurses and NHS staff available to work in the community to ensure that we do not send people home only to see them return unnecessarily into acute care.

Lord Macpherson of Earl's Court: My Lords, we may or may not be experiencing one of those periodic crises that beset the NHS and the social care sector every 10 years or so, and by the time we know for certain it will be too late to do anything about it. Indeed, even if the Government announced another £1 billion of spending today, the lead times are such that it would not have any impact until well into the next financial year. However, if there is not a crisis this year, it will happen next year or the year after that.
The coalition Government were right to try to secure efficiency improvements out of the NHS and social care sectors, but the squeeze has gone on for too long. Although the Chancellor announced more money in his recent Budget, it was more a temporary sticking plaster than a permanent solution to NHS finance problems. The NHS will come under further pressure in the years ahead as the demographic pressures long predicted by the independent OBR and others begin to materialise. Those spending pressures are compounded by the so-called triple lock, which means that pensions and health spending are accounting for an ever-increasing proportion of public spending. It is no longer realistic to cut spending on prisons, the police and defence; they too are under heavy pressure. So something has to give.
The NHS is the last great socialist institution, free at the point of use and based on the principle of command and control. Its founders were wrong when they predicted that better healthcare would reduce demand. The fact is that demand is infinite. We now know that demand increases as society becomes more prosperous so healthcare, under the NHS model, will always be rationed. Governments are inevitably reluctant to admit this but it is a fact, and it may be no bad thing. The NHS is certainly a lot cheaper than the US private system, which is beset by waste caused by supplier-induced demand.
Such is the British people’s attachment to the NHS that I do not think it is realistic to change its founding principles. Of course the NHS could be better managed. For example, we need to find better ways of managing demand. Far too much money is wasted on patients who fail to turn up for appointments. We also need to solve the age-old disconnect between the NHS and social care. I welcome recent government efforts to address this, although there is still more to do, but better management and reform is not going to be enough. If we are to avoid future winter crises, we need to address the funding side of the equation.
Despite the Treasury’s excellent presentation in this year’s Budget, the Chancellor’s proposals effectively financed extra spending on the NHS through higher borrowing. That is not the right approach. The current pressures are structural and on revenue spending. Good stewardship should ensure that structural spending is financed out of higher taxes. It would run against the orthodoxy that I imbibed over 30 years at Her Majesty’s Treasury but I propose a hypothecated tax that would be set at the beginning of each Parliament, informed by independent projections by the Office for Budgetary Responsibility. A new NHS and social care tax would be introduced to fund these additional pressures. It would be based on national insurance contributions, which, incidentally, already include a little-known NHS allocation. Unlike national insurance contributions, the tax would be paid by those above retirement age as well as those below it, and it should be charged on savings, rental and pensions income as well. The fact is that young people are already bearing too much of the burden of funding the elderly. It is time that the old folk put something back. We need greater solidarity across the generations.
This new NHS tax would be separately itemised on people’s pay slips and could be spent only on the NHS and social care. In my view, taxpayers would be more prepared to pay higher taxes if they knew where the additional money that they raised was being spent. A 2% tax, paid by young and old alike on incomes above the lower earnings limit of national insurance, would raise well in excess of £10 billion a year. I hope the Government will give it serious consideration.

Bishop of Carlisle: My Lords, as ever, much of what I might have wished to say has already been said so I will not repeat it. I will try to keep my contribution brief.
In one sense, the current situation in health and social care, which, as we have heard, has been widely  reported and analysed by the media, is nothing new. Admittedly, the number of patients with flu this year, especially elderly ones, has not helped. Last year, though, in its document entitled Winter Warning, NHS Providers commented that, “NHS performance last winter”—that is, 2016-17—
“showed unacceptable levels of patient risk as growing demand outstripped NHS capacity”.
Every winter has brought its own challenges, and short-term problems and pressures are not necessarily indicators of long-term difficulties. At the same time, though, as we all know, and as was pointed out by the noble Lord, Lord Macpherson of Earl’s Court, an increasingly large and elderly population with multiple morbidities has been steadily putting a huge strain on both the NHS and social care in this country.
The delivery of services is not an issue only over the winter period: it is a constant headache, not least in accident and emergency departments across the country, but also in care homes and private homes that are struggling to cope. As the noble Baroness, Lady Wheeler, pointed out, in a recent survey, no less than 91% of trusts reported a lack of social care capacity as winter approached, despite the promise made in the March 2017 Budget of an extra £1 billion for social care in 2017-18.
This emphasises the need for two things to happen, one of them short term, the other long term. The short-term need should be relatively straightforward to meet. It involves not only planning for next winter now but making sure that the necessary funding is released well before the winter actually arrives. As the noble Baroness, Lady Wheeler, reminded us, in the Budget on 22 November 2017 the Chancellor of the Exchequer committed £337 million to address winter pressures. That was very welcome but it came about four months too late. Health and social care providers are clear that any extra funding to help with the demands of the winter period needs to be committed by the end of July at the latest to enable effective planning.
The longer-term need is rather less simple but even more important. This is the need to tackle the thorny issue, alluded to several times, of the long-term sustainability of both the NHS and social care. I had the privilege of sitting on the ad hoc Select Committee of your Lordships’ House chaired by the noble Lord, Lord Patel, which produced a report on this exact topic last year. Unfortunately, the report came out just before the general election, which means that we are still awaiting a response from the Government and proper debate on its many recommendations.
Those recommendations relate directly to the subject under discussion this afternoon. Recurring winter pressures cannot be separated from the pressing need to address the ongoing issues around sustainability, including personal responsibility, increasing integration—we welcome the new Department of Health and Social Care—workforce planning, a model for funding and, above all, a non-party-political group, rather like the OBR, to advise the Government of the day about long-term requirements.
I greatly look forward to that debate in the hope that it may help to mitigate the need for ongoing debates such as this.

Baroness Eaton: My Lords, I declare my interests as a vice-president and former chairman of the Local Government Association.
Health and social care are vital services that support our nation. Social care helps to reduce pressures on the NHS, by both supporting people to be discharged from hospital and helping to prevent them needing hospital treatment in the first place. It is an essential public service that helps working-age disabled adults, older people and their carers, as well as promoting well-being and independence.
The money the Government have brought forward for both the NHS and social care is welcome, particularly during the winter, when there are increased demand on services but, as we have heard, the timing of such allocations needs to be more realistic to be really helpful. It is also encouraging, as mentioned by the noble Baroness, Lady Pitkeathley, that the Government have included “social care” in the Secretary of State’s job title and appointed a Minister in the department with responsibility for the service. This shows that health and social care should now be afforded the same level of political importance across government.
A great deal of the public debate this winter has focused on problems associated with the delayed transfer of care, particularly as the pressure increased on NHS beds and staffing. Local authorities remain committed to supporting people as they are discharged from hospital. It is positive that councils have reduced delayed transfers of care attributable to social care by 20% since July 2017, which was when the Government first introduced the target. As the noble Baroness, Lady Wheeler, said in her opening remarks, citing the LGA, delayed transfer of care is a symptom, not the cause, of the pressures on the NHS. In many cases, the solutions are additional investment in prevention, primary care, community services and initiatives that keep people out of hospital.
It is crucial that, in the important debate on how we make sure our NHS is funded, we do not lose sight of social care. We cannot have a sustainable health service without sustainable, and sustainably funded, social care. The LGA estimates that social care faces a £2.3 billion funding gap by 2020. According to the LGA, the financial situation is making it increasingly challenging for local authorities to fulfil their legal duties under the Care Act. The message from local government and the wider care and support sector is that the situation is now critical and we need political agreement nationally and locally on the solutions. That is why it is important that we have a national debate about how we ensure high-quality, sustainable health and care services in future. With this in mind, I welcome the Government’s commitment to bring forward a Green Paper on social care by the summer.
In my closing remarks, I ask the Minister whether, further to suggestions being made by Members in the other place and by the noble Lord, Lord Macpherson, today, the Government are considering hypothecated tax for the NHS. If they are, will the option be consulted on in the Green Paper as the Government look at the funding model for social care? Our health  and social care services are essential to the nation’s well-being. These services look after people when they need it most, care for them and help them live healthy lives. We need to work hard across this House, in the other place and with national and local government to find political agreement on how to ensure that we can continue to provide a high level of care for generations to come.

Lord Pendry: My Lords, I begin by thanking my noble friend for initiating this important debate. She exactly the right person to do so, bearing in mind her trade union background—as an official of a union which happens to be mine, serving public employees including various union members in the health and social care sectors. I also thoroughly enjoyed hearing the contribution of my noble friend Lady Pitkeathley, a real champion for carers, as was reflected in her speech. I have another reason to be grateful to her: together with the late Lord Alf Morris, she ably steered through this House my Private Member’s Bill, enabling it to become the Carers and Disabled Persons Act 2000. The limit on the speeches in this important debate is so restrictive that I can make merely a few points, with apologies to Carers UK, Age UK and others who have taken the trouble to give me material for my contribution.
I have long since advocated the merger of health and social care within one department. After all, they are one of another. It is clearly a step in the right direction, and I must say that some credit must go to the Secretary of State for standing up to the Prime Minister, who wanted to sack him. He has shown some muscle by standing his ground. We now know that he has the opportunity to flex those muscles with his new title embracing social care. But he must now ensure that cash follows this important step forward. If not it will be seen as just a gesture—merely a change in name with little substance.
Now we all await the long-overdue Green Paper, which should be followed quite quickly by a White Paper and an Act of Parliament, reflecting the true purpose of the 1947 Act. In truth, there is no clear definition of social care for it is so diverse—from cradle to grave, and taking in the current plight of our children who rank in the lower leagues of Europe and beyond. While Scotland and Wales face similar funding strains, they are coping rather better than England, having introduced measures such as banning smoking in playgrounds in Wales and developing stronger mental health schemes for children in Scotland. Child poverty is at its highest level in the UK since 2010, and measures need to be taken to ensure that the health of our children is not being put at risk.
At the other end of Mr Hunt’s responsibilities is tackling the plight of the elderly in our society. The care system in the country is close to breaking point, and it is estimated by Age UK that there has been a real-terms public spending cut of some £160 million to older people’s social care in the last five years. It goes on to point out that 1.2 million people aged 65 and over are in need of care and support, which  represents an 18% increase on last year alone. It means that one in nine are living below the poverty line, which is a disgrace in one of the richest countries in the world.
I cannot conclude my remarks without stating something said by my former GP and vice-president of the BMA, Dr Kailash Chand. He points out that the Government’s health plans are based on the reverse of NHS principles; instead, the greater your care needs, the more you pay. In the case of social care, which is beset with multiple providers, there is less state provision and more privatisation. That is also my view. Mr Hunt now has a golden opportunity to prove his critics wrong, and I hope he can do that. He has the perfect occasion to do so when eventually the Green Paper arrives. So, Secretary of State, this is your chance to shine.

Baroness Pinnock: My Lords, I draw attention to my interests as a local councillor in the borough of Kirklees, and as a vice-president of the Local Government Association.
The stark facts are that in the last winter period, there were an estimated 34,300 excess winter deaths in England and Wales. That is a shockingly high figure and one on which I hope we will seriously reflect. Last October, a joint university research team found that of these excess winter deaths, around 8,000 a year may be caused by “deadly” levels of so-called bed blocking. NHS England regularly reports on delayed transfers, and the latest report cites a number of reasons for them: insufficient capacity in intermediate bed-based so-called step-down care; social care assessments and agreement with families for transfer to residential care; and delays in providing home care support for those who can continue to live in their own homes.
Leaving older people in hospital when they are able to go home has a very high impact on the individual, their family and other patients, as well as additional costs to the NHS, obviously. However, it is hardly surprising that these delays occur with such devastating consequences. Professional bodies and local government have been making it clear for many years that the funding of adult social care is at crisis point. As we have heard, the LGA estimates that there is a £2.3 billion per year shortfall in the funding necessary for adult social care. This figure is confirmed by work done by the King’s Fund. The result is that local authorities have been steadily reducing care costs and defining ever higher eligibility criteria. So across England, spending per adult resident on social care fell by 11% between 2009 and 2016—that is according to the Government’s own figures.
Ten per cent of councils have cut their spending on social care by 25%. Think about what that means to vulnerable older people who need social care in those areas. Councils serving more deprived areas have had to make even deeper cuts to social care budgets, despite clear evidence of efforts to protect social care spending. The more deprived an area, the higher reliance on government revenue support grant, hence the larger the cut in the spending power of these councils, as the Government, year on year, cut the revenue support  grant to fund them. Local authorities have had to respond to much reduced budgets by putting pressure on the costs of local authority-funded residential care and home care. The result is not surprising: care homes cross-subsidise by higher payments from self-funders. That is a scandal waiting to hit the headlines.
Rationing has resulted in the number receiving care falling by 25% between 2009 and 2014—and I am sure that that has risen in the couple of years since then. Consequently, older people are struggling for longer on their own and the tendency is for this to escalate into more acute episodes requiring acute care in hospital. It is quite obvious that a significant part of the solution is for the Government to provide adequate funding for adult social care.
The Government’s response to this crisis of funding has been woeful. A much-publicised £2 billion has been added to the social care budget, but that is over three years—in other words, a mere £600 million a year in the face of a need for £2.3 billion a year. The additional £1 billion provision in the 2017 Budget has come with very long strings attached. A lot of it has gone not to adult social care budgets but to the better care fund, which is about collaboration between the NHS and social care services. The Government have decided, in the face of this funding crisis, to put the burden of social care costs on to what they have previously as “hard-pressed council tax payers”.
Councils are able to charge a 3% social care precept for two years, but council tax is a regressive tax system that takes no account of ability to pay. Furthermore, a council tax rise of 1% raises very different amounts according to the rateable values in the council district. So 1% in my own borough of Kirklees raises £1.6 million, and a 3% rise barely covers inflation. The consequence is that Kirklees Council will, reluctantly, further reduce expenditure on adult social care this year.
The Government have enhanced funding for the NHS and social care through the better care fund but, in my experience, the NHS and local authorities have, quite rightly, used this fund to develop more collaborative approaches, which do not impinge on the immediate crisis. Does the Minister accept that adult social care funding needs to be substantially increased year on year to meet the shortfall predicted by 2020? I look forward to him providing some positive hope in the promised Green Paper of the Government’s willingness to accept the crisis for what it is: a consequence of inadequate funding.

Baroness Watkins of Tavistock: My Lords, I draw attention to my interests as outlined in the register. I thank the noble Baroness, Lady Wheeler, for securing the debate on this important topic and for her excellent speech which, together with that of the noble Baroness, Lady Pitkeathley, and others, covered some areas which I will now not repeat. This topic should be of concern to all parties in this House, given the public’s expectation of access to high-quality provision, not only of healthcare but of social care.
Some 40 or 45 years ago, when I was at school, I read in a series of papers about the scandal in mental hospitals. It really encouraged me to go into mental  health nursing and improve the lot of people who now no longer suffer in that way in institutional care. However, in the Times last week, there was the headline:
“A million lonely pensioners left to starve in their homes”.
A group of MPs from across all parties have talked about this. We are beginning to create what we had in institutional mental hospitals 40 years ago in people’s own homes, where they are even more isolated and alone than those who were in the system that I worked to change.
In all four countries in our United Kingdom, patients are waiting in ambulances or on trolleys in A&E prior to the full assessment of their conditions. One reason is that our acute hospitals are full, with bed occupancy rates of higher than 90%—completely different to the international recommendation that 80% to 85% is a safe way to practise. We know, as others have already outlined, that this is frequently because patients who are deemed fit enough for discharge are not fit enough to go home without significant levels of social support and care.
Rural England reported earlier today that, in Cornwall, there are on some days 60 people in hospital who are ready to go home, but part of the problem is that it is difficult to recruit home carers. Is that a surprise, when these carers are on less than £9 an hour and are not paid to travel, particularly in rural areas? At least when I was a district nurse I was paid for my travelling time. Patients are therefore held in ambulances, although with excellent paramedic care and support. Yesterday, South Western Ambulance Service NHS Foundation Trust told me that this costs about £66 an hour for individual ambulances and the clinical crew. Let us compare that to the £9 an hour for carers—if we could just turn the system around, could we not improve for the same amount of money? We know that people wait for long periods for discharge from hospital, which costs a minimum of £450 a day. We need a coherent total systems approach to health and social care. How can we do this? Well, is it not time for the Department of Health and Social Care to reimagine community services, as the recent King’s Fund report suggests?
As a short-term measure, we could set up some pilot sites, with acute trusts given the funds and authority to purchase and maybe even provide community support, including residential and nursing homes, for the first six weeks after discharge. Indeed, we could set up success measures to see whether we can reduce social isolation, enhance older people’s nutrition and thereby reduce admissions.
We need not only to remember that the current situation is affecting social care but to think about the perception of those whose planned operations have been postponed. These elective operations involve both young and older people, perhaps waiting for a simple hernia repair or orthopaedic operation. How do they feel about our NHS? Surely they would rather have innovative solutions than stay with the status quo. The issue of intergenerational fairness and a potential hypothecated tax was raised by the noble Lord, Lord Macpherson. We will turn the next generation off the health service unless we can provide the care they need as well as the care for their grandparents.
What plans are there to consider more innovative pooling of health and social care budgets, to provide the best seamless care for our people, and to reduce the stress caused not only to patients but to NHS and social care staff in our hospitals and community teams who—believe it or not—want only to provide high-quality services to those they serve? These are the questions that our staff want answered and we need to answer to encourage recruitment and retention in our vital services. I have given some of the simplest costs in financial terms that the public would understand, so surely a reorganisation with a community focus for older people’s care may enable better services for the same cost. This of course also includes suitable housing for frail elderly people and, possibly, NHS nursing homes.
Finally, does the Minister agree with a summary in a paper on economics from the BMJ last year, which concluded that spending constraints, especially for personal social care, were associated with a substantial mortality gap? The paper suggested that spending should be targeted on improving care delivery in care homes and people’s homes, and on maintaining or increasing nursing numbers.

Baroness Hollins: My Lords, I remind the House that I am a family carer, retired psychiatrist and a past president of the British Medical Association, whose work I will refer to during my speech. There has been a lot of talk and publicity about the pressures on what are termed acute services. We have all seen the television images of trolleys and the problems in accident and emergency and so on; they make headlines and they are provoking debate—and I welcome today’s debate. One solution will indeed be a focus on the problem of delayed transfers of care back to the community. Without taking attention away from these important areas, I want to highlight similar concerns within mental health services, which seem to me to be as acute in nature as those described in general hospitals—although, in truth, they are not just confined to winter.
The British Medical Association’s bed occupancy report highlighted particular problems with high bed occupancy and delayed discharge in mental health settings. It identified the main reasons for delayed discharge as being a lack of suitable community services or facilities to support patients at home and a lack of available beds within local community or specialist facilities. Of particular relevance, given the ongoing review into the Mental Health Act, the BMA report noted an association between the reduction in mental health beds and the increase in the number of patients admitted following detention under the Mental Health Act, with the balance shifting towards a more acutely ill in-patient population. It seems sometimes that people have to be sectioned to get a service, even if perhaps that might not otherwise have happened.
In December 2017, the mental health charity Mind published its survey of over 1,000 people discharged from mental healthcare facilities and reported that patients found planning for their discharge was rushed and unsatisfactory, and that around half of patients  experienced inadequate planning and support with housing and finances before discharge. If I had more time, I would give noble Lords some examples. Given these issues, it is surprising that the framework in the care Act for addressing delayed transfers of care seems to overlook patients with mental health conditions. One of the mechanisms to promote integration and co-operation between the social care sector and the NHS is the system of local authorities reimbursing the NHS for a delay in transferring care. This system is viewed as an incentive to improve joint working between health and social care. However, the provisions do not apply to mental health care, which is explicitly excluded from this framework. In fact, I understand that the only way a mental health patient may benefit from this framework is if they are unfortunate enough also to develop a physical illness that requires treatment under an acute medical consultant, but of course, ensuring adequate care planning for someone with a significant long-term social care need who also has an acute medical condition requires additional time and skill.
By no means do I think that fining local authorities is the sole mechanism for integrating social care and the NHS. The issue is rather more complex than such a blunt measure could resolve. However, that it is excluded from this framework suggests something about the way mental illness is prioritised compared with physical illness. If increased integration and co-operation between the health service and social care is what is needed for physical illness, why is it not also prioritised for mental illness? If the reimbursement provisions in the care Act are felt to drive integration and co-operation for those with physical illness, why not apply it to mental illness also?
While my amendment to the Health and Social Care Act 2012, on parity of esteem, may have helped to raise concerns and awareness of mental illness and parity of service provision, and outcomes are now regularly raised as critical goals in a modern health and social care system, this debate highlights yet another area where it is partly missing. Although I am very grateful to the noble Baroness who initiated the debate for referring to these issues, what worries me when we hear talk of winter pressures, black alerts in hospitals and crisis management is that it is in this environment that those with the most complex health and social care difficulties can be overlooked. Whether we expected such problems in advance or not, this is not an environment where we can deliver the best care for the most vulnerable people. Care services for vulnerable adults need to be part of a long-standing sustainable system. We cannot rush their discharge just because it happens to be winter. In fact, it is at this time when we should be most careful about discharge planning. Do we have more social workers, community mental health workers, community care placements and district nurses during the winter season in order to pick up the work from the overstretched general hospitals, or do we just settle for less robust discharges? If the latter, then clearly, those with complex mental and physical needs will suffer most—the very people who often find it hardest to make their voice heard.
A sustainable health and social care service cannot run at two different speeds: one for summer and one  for winter. Careful, considered, joined-up care is needed all year round. This care does not suddenly appear when a winter crisis is identified.

Lord Desai: My Lords, I welcome this debate. Thankfully, much of what I wanted to say has been said by the noble Lord, Lord Macpherson of Earl’s Court. I wish that more Treasury mandarins like him retired, came here and became progressive. We would welcome that.
However, at the bottom of this crisis, which is not new but occurs perennially, is the fact that we have undertaxed ourselves and refused to raise the resources necessary to enable a civilised society to look after itself. We have not taken on board the seriously high cost of living longer. Our pension systems have been wrecked by that because, when we started them, we thought that people generally lived about 10 years beyond retirement. However, if people live 30 years beyond retirement, the pension system is wrecked. I agree with the noble Lord, Lord Macpherson—indeed, I do so because I proposed this measure—that there should be a hypothecated tax system and national insurance contribution, as he said, with much stiffer taxation for self-employment, which I think is a species of fraud practised upon the tax system. Indeed, in the Budget before last, the Chancellor tried to tackle that problem but he was shot down in no uncertain terms. We have to stop believing that tax cuts are great, borrowing is bad and that somehow in between we can finance a welfare state. Therefore, we should definitely have a hypothecated tax.
We should also tackle the financing of local councils. We have a tax, the council tax, which is, of course, regressive. But worse than that, it is frozen at old levels of house prices. We proudly proclaim how much house prices have gone up but for many years we have not taxed the capital gains that home owners have made. It is time that we tackled that question. Some noble Lords will remember that it was when we had to revalue properties in the light of the rise in prices way back in the Thatcher Administration that the entire fiasco of poll tax happened because of the timidity of that Government in revaluing property. Again and again, Governments have not revalued property and therefore council finances have suffered. It makes no sense whatever. We need a serious revaluation of private properties. You may keep the council tax rate the same, just move the bands up. A lot of people would move up the bands: that is the reality. If people pay the appropriate tax, they will receive good social care in return, so they would not lose anything. As I say, we need a hypothecated tax and we need a revaluation of council tax.
Something was revealed to me last week in a report of the National Audit Office on the PFI and all those things. The Carillion disaster has coincided with some early nights so I read that. When PFIs were proposed, it was quite clear that it was a piece of imaginative accounting and the Government could borrow off the balance sheets and pretend that they were being fiscally responsible but at the same time hiving off a huge debt. The important point is that that borrowing was  very fruitful for the NHS. We need that kind of borrowing to expand hospital capacity and the health and social care infrastructure. Whether you do that kind of borrowing under a PFI or openly is a question we can go into. But given that currently the rates of borrowing are very low, now would be a chance—perhaps the last chance very soon—to borrow a lot of money dedicated to improving the health and social care sector. We cannot go on complaining about winter deaths and not pretend that it is the lack of resources which is causing this problem. So we need more taxation. I was sacked twice from the shadow Front Bench for proposing more taxation, and that was in the Labour Party before new Labour. I do not want to get anyone sacked but I think it is still worth saying that we are an undertaxed nation and we are paying the price for that.

Lord Kerslake: My Lords, I declare my interest as president of the Local Government Association.
“Our NHS … is in crisis and the adult social care system is on the brink of collapse”.
These are not my words but the opening line of the report of the ad hoc committee The Long-term Sustainability of the NHS and Adult Social Care. Chaired by the noble Lord, Lord Patel, it was published in April of last year, and as we heard earlier, we have still to see a response from the Government. It would be good to hear from the Minister when that response will be received. The recent headlines have focused on the intense pressure on the NHS. Today’s debate provides a welcome focus on the less visible but no less important issue of social care, and I am very grateful to the noble Baroness, Lady Wheeler, for organising it.
My first and most important point is that we do not simply have a winter crisis. We have a crisis of funding in the NHS and social care, which has been brought into sharp relief by the additional pressures of winter. I have no doubt that every effort has been made nationally and locally to prepare for winter. There are certainly some excellent individual examples of local services taking action to minimise hospital admissions and delayed discharges. But the issue here is systemic and not seasonal. Without action to address the fundamental issue of funding, no amount of work locally, excellent though it is, will stop the problem from getting worse. In the meantime—this is a crucial point—we are putting intolerable pressure on the system and the people who work in it.
A lot has been said recently about the shortfall in NHS funding. I will simply quote what the very well-respected chief executive of the King’s Fund, Chris Ham, said in a blog he shared with me at the time of the Budget last year:
“In the 40 or more years I have worked with and for the NHS, I can’t remember a time when the government of the day has been so unwilling to act on credible evidence of service and funding pressures”.
Put simply, the Government are in denial of the scale of the problems. But, as the LGA put it so well in its brief for today’s debate, there cannot be a sustainable NHS without a sustainable adult social care system, and, in my view, the current position is not sustainable. Give or take a bit, social care—adults and children—takes up about half of local government funding. Since 2010,  local government spending power has been reduced by around a third. The brunt of this reduction has been borne by staffing reductions and cuts in universal services such as highways maintenance and libraries. Children’s care pressures have, if anything, increased in that period. So it does not take a great mathematician to see that however hard local government tries to avoid reductions in adult social care—and I know from personal experience that it does—cuts will be inevitable. The extra money and the increased flexibility on council tax are welcome but, as others have said, they are nowhere near enough. Crucially, the LGA has said that by 2020 there will be a £5.8 billion funding gap in local government as a whole, of which, as we heard, £1 billion is to do with social care, and we have another £1.3 billion of pressure on the provider sector.
Many people have said that this problem can be solved by simply bringing the funding streams together. By giving control to one Minister, the newly named Secretary of State for Health and Social Care, local government can somehow be “brought into line” on delivery. I urge extreme caution on this. First, the squeeze on local government is across all aspects of its funding. People want to see clean streets and maintained roads too. You cannot simply deal with social care in isolation from the rest of local government finance. Secondly, because of the increased retention of business rates, most if not all local authority income will come from locally generated and retained income sources. It will not be in the gift of any government department to give control over that. So bringing together health and care is a good thing, which results in better and more joined-up services. But it will not solve the funding gap.
Money is not always the answer. But in this case it is inevitable and essential that it is provided. We need an immediate cash injection to stabilise the system, but we also need a royal or cross-party commission to look at the longer term. We must engage in a debate with the public on what kind of health and care system they want, how much it will cost, and how we should pay for it. Like the noble Lord, Lord Macpherson, my view is that it should be a hypothecated tax on both income and wealth. But let the commission decide on the options. We might then, with that commission, be able to address the urgent questions set out in the Select Committee’s excellent report.

Lord Smith of Leigh: My Lords, I too welcome this timely debate, which has been initiated by my noble friend. I declare an interest as yet another vice-president of the LGA—that makes three of us so far, and our president has spoken. I am also leader of Wigan Council and chairman of the Greater Manchester Health and Social Care Partnership, so I can see these issues from both sides—although whichever way you look at them, it is not a pretty sight.
Reading in the press about the daily problems in A&E, it is tempting to talk about a winter crisis, as many noble Lords have done, but like the noble Lord, Lord Kerslake, I think that this is not a winter crisis but symptomatic of the general crisis in health and  social care. Fundamentally, it is caused by the ageing population—which should come as good news in your Lordships’ House: we can live longer—but obviously that puts pressure on both the health and social care sectors. We have not commensurately increased money for the health service to reflect the increased pressure that comes with an ageing population, and in social care, as we have heard, there has also been a reduction. Although noble Lords have concentrated on the revenue side, it is also true of the capital side. To refer to one example, Watford General Hospital was built and designed to take 45,000 to 50,000 admissions per year. It currently deals with 90,000. Is it remarkable, then, that it has had to use corridors and other places to deal with admissions?
Workforce issues are key in the NHS. Although we know that the NHS suffers shortages generally, it is particularly true in A&E, which is not the most popular area for people to go into. It has been said that we are 2,000 consultants short in A&E, and of course the numbers in nursing are going down too. As we saw in the report last week, the numbers leaving the nursing profession outweigh the numbers going in. Although that is caused by a great number of factors which I will not go into, it puts severe pressure on those who remain. Finally, there is a lack of integration between health and social care.
Now that the Secretary of State has acquired an additional title he will discover that funding is the most fundamental issue he faces in social care. Colleagues have talked about the quantum of money. That is important but we should also remember to ask who will pay for social care. The Tory party made a bit of a mess of it in the last general election when it tried to talk about how much individuals should contribute to social care. The Tory party is very unclear on that point. In the short term, the Government have tried to put more of the burden of paying for social care on to local taxpayers: instead of putting up general taxation, they have put up local taxation. The noble Baroness, Lady Pinnock, mentioned one aspect of the regressive nature of council tax. I could spend all of my allotted time here or longer talking about reforming council tax—a subject referred to by my noble friend Lord Desai. It is something that I have long advocated.
The other issue is that the council tax situation between local authorities is unfair. For example, many northern authorities like mine have more properties in the lower tax bands than do other places. Therefore, a 1% increase in council tax gains six times as much in Richmond and five times as much in Windsor and Maidenhead as it does in my authority. We might say, “Well, we’re all giving 1%”, but that 1% raises very different amounts of money, and that cannot be justified.
Although health and social care needs more money, the fundamental problems are such that we cannot just put more money in. We need to change the NHS from being an ill-health service, which, on the whole, it does pretty well, to a proper health service. I wonder whether anyone has read the recent report on children’s dental health. We are spending money on repairing and replacing children’s teeth instead of simply getting them to clean their teeth. Yesterday’s Times reported  on lifestyles which are likely to cause long-term problems. People will be four or more times likely to develop chronic conditions by the time they get to 65, and that will mean more pressure on the NHS. Unless we put more effort and energy into prevention and early intervention, the extra demand will eventually overwhelm not just the NHS but government overall.
I do not want to end on too desperate a note—there are reasons to be cheerful. In my authority, the use of transformation funds from Greater Manchester will make a difference. We are working to keep lots of vulnerable people in care homes. We have a 180-bed care home which we think has saved 36 people from going to A&E. We are also working with GPs, many of whom have to deal with what are really non-medical issues, such as housing problems, fuel poverty and loneliness. Those are issues where GPs try to provide medicines but those are not the answer. We need to turn the system around. That is a real challenge and we need real leadership to do it. I hope that the Secretary of State is up for it.

Lord Warner: My Lords, I too congratulate the noble Baroness, Lady Wheeler, on securing this debate and on her elegant demolition of the Government’s winter planning. I also welcome the conversion of the noble Lord, Lord Macpherson, to hypothecated tax—having left the Treasury—as well as his rather telling analysis.
Each night the BBC brings us the latest bulletin on what is happening in our hospital, GP and ambulance services up and down the land. Sick patients wait on trolleys and in cubby-holes for a doctor to see them; ambulances queue to discharge their patients and then cannot leave because they cannot get their trolley back; cancer patients wait longer and some probably die sooner; and surgery waits lengthen as more operations are cancelled. Welcome to Britain’s 21st century NHS, often said by Ministers to be the best in the world. What the Government have achieved, I suggest, is to make Hugh Pym a household name.
This winter’s crisis has highlighted how dysfunctional our health and care system has become and how difficult it is for staff to work in it. Committed doctors, nurses and a multitude of other staff are being driven to exhaustion and burn-out. Their good will and professional commitment are being taken for granted and will not last—they are rapidly evaporating. We are now well past the point where the promise of a Boris £5 billion bung in a glorious post-Brexit future will encourage the staff to stay. What people working in the NHS and social care want to see is a credible and funded plan for fixing a broken NHS business model, and rebuilding and aligning the social care system effectively with the NHS.
The Government remind me a bit of Blackadder waiting for Baldrick to come up with a cunning plan. Even when they were given a respectable route map by your Lordships’ Select Committee last April, they did not seem to know what do with it. Ten months later we still await a response. The 2011 Dilnot proposals for capping individual liability for care costs was legislated for and then abandoned. Social care reform has been kicked into the long grass following the election campaign  fiasco. We now have yet another review, which almost certainly will delay any substantial reform until the early 2020s. Sadly, I think that this Government are so preoccupied with Brexit that they lack the bandwidth to get to grips with the complex and difficult problem of making our NHS and social care system fit for purpose for 21st century needs.
Yet the narrative on social care is appalling. There has been a 25% to 30 % real-terms funding cut since 2010, and that is only starting to be reversed this year. The shortfall from these cumulative cuts will never be made up. The absence of further funding in the Autumn Budget and the local government finance settlement means that a further funding gap of £2.3 billion is now emerging. Those are not my calculations; that is according to the Conservative-led LGA.
Hundreds of thousands fewer people now get publicly funded social care than in 2010, and the numbers are continuing to rise. Furthermore, thousands of care beds have simply disappeared from view. In this situation, why should we be surprised that so many older people now turn up in A&E and hospital beds? The Government were warned repeatedly that this would happen, and now it has. It is inevitable that many local authorities simply will not be able to reach the Government’s totally unrealistic and “undeliverable”—not mine but the Conservative LGA’s word—expectations on delayed transfers of care from hospital. The Government seem reluctant to face up to what we have all known for some time—that a sustainable NHS requires a sustainable social care system.
If the Government want to avoid continuing NHS crises, they must start spending more money now on social care than they are currently planning to do. They must do this for the next three years or so while they work out a longer-term funding plan. That means probably allocating a further £5 billion to £6 billion over the next three financial years. In order to be a bit constructive, as a short-term expedient I suggest that the Minister and his colleagues start quickly to think about reducing hospital bed-blocking by funding more transfers of NHS patients to step-down care in nursing and residential care homes as part of NHS continuing care, instead of waiting for the unavailable care packages.
Finally, I want to say a few words about NHS sustainability, and this is where I share the views of the noble Lord, Lord Macpherson. No Government can have a sustainable NHS that meets the population’s needs without a plan for handling the unrelenting rising demand that has an unaffordable funding tab of a 4% increase a year. This Government have no such plan and, as far as I can see, nor do the Opposition. This Government have demonstrated that you cannot achieve NHS sustainability with funding increases of a little over l% in real terms a year for the best part of a decade and with no investment strategy for changing the wrong business model to meet demand. Unless we change faster the way that we deliver health and social care, we will be setting up the NHS and its staff to fail. We also have to ensure that when we give the NHS more money, sufficient of it is ring-fenced for investment and that it does not go towards propping up the present system.

Lord Brooke of Alverthorpe: My Lords, I too am grateful to the noble Baroness, Lady Wheeler, for initiating this debate and to everyone who has participated in producing a set of solutions which, if they were brought together, would solve the problem. I feel sorry for the Minister, who has had little support from any quarter today for his problem.
Everyone knows that much more money is needed. There is a 2% gap that needs to be filled and one way or another we have to find measures—basically through taxation—to meet that need. We also need to look for other ways in which funds can be raised in which we might involve the wider public so that, in turn, we get a greater recognition—to pick up the point of the right reverend Prelate the Bishop of Carlisle—that there has to be more responsibility for the NHS across a broader front. It is not only an issue of the Government providing the money but of how we care for ourselves and each other, of how families care—or do not care—for the elderly, and of how families pay for the elderly or refuse to do so because they want to keep the house for themselves in due course. When these issues are raised, there is a row and people run for cover because they are far too difficult to address.
As the noble Lord, Lord Smith, said, I hope we can spend some time addressing the winter problems, but we see these problems all year round. I bore the House to death when I go on about alcohol and A&E and the costs involved. When the Minister took his job, he said that he was going to stamp down on drunkenness in A&Es. I would like to see some evidence of that because the papers were full of such issues over the Christmas period.
Substantial numbers of people go to hospitals and A&E when they should not be there. I am probably the only Peer here today who was in an A&E department on Christmas day, when we had a family incident. I was there at 10 o’clock through until three o’clock in the morning before the family member was moved into an acute assessment ward and kept in for five days. We were not overrun, to my surprise, by the number of people I had anticipated being in A&E. However, given the relatively small number of patients there, we were, to a degree, overrun by the number of friends and relatives who went along with them. There were four or five people with each patient, creating noise on mobiles, causing confusion and making it much more difficult to manage the A&E. Some simple things need to be addressed. Why do we need so many people going into A&E when it causes a delay in patients being dealt with?
Similarly, when we got to the ward there was very little management and it was difficult to determine who was in charge. People were coming in, shouting and screaming down their mobile phones, and patients were surrounded by four, five or six people spending three, four or five hours in there. If people wanted to make a complaint about it, there was nobody around who was able to address the issue and slow it down. Hospitals used to be about patients, peace, calm, serenity and recovery. During that week, I was in that hospital every day—my Christmas was lost—and my experience, in many respects, was that I was in a place  of riot and chaos. It should not be like that in a hospital. It would cost very little money to put this right, but it needs addressing. I know it is a minor issue compared with what we have debated today.
I return to the topic of alcohol. Cheap booze is a source of many of the problems within A&E—not only at Christmas but throughout the year, from Thursday evenings through to Sunday—and that has to be addressed. It is amazing that the Chancellor is struggling to find money for the NHS and yet, on the other hand, he is freezing the regulator in terms of increasing the cost of alcohol duties. He is making alcohol cheaper on the one hand and on other is struggling to find the cash to keep people well. We now have more people drinking less but certain categories of people drinking more. More people are now going into hospital with less alcohol being drunk, and the price of alcohol, in the main, is going down rather than up. Fairly simple action could be taken on that by adjusting taxes. This would put it right and we would have a good response all the way round. We should apply it across the board—for example, with sugar and a range of other issues. We should look at the polluters who cause the problem to see whether they could make a greater contribution.
At the end of the day, much of this comes back to public health campaigning and how we look after ourselves and each other. Regrettably, the amount of money which has been spent on public health has been cut over recent years. We need to review that and start looking at ways in which we can help people to look after themselves better in the future, live longer and lead better and happier lives than they are doing at the moment. That requires bold decisions, frankness and honesty, which, regrettably, so far the Government have not been prepared to engage in.

Baroness Jolly: My Lords, this has been an interesting debate. There are many experts and much experience in this House. There is also a great deal of passion and it is not surprising that there is a lot of agreement.
I start by thanking all care workers who, on low wages and often with little thanks, do a splendid job, day in and day out, whether in a hospital, residential or nursing home, or in a domiciliary setting. There are 1.4 million people employed in social care roles, caring for more than 1 million adults. The winter period is often challenging. Certainly in the rural area where I live, these people have to cope with bad weather, dark morning starts and dark evening finishes, and, invariably, with clients who are less well.
The other unsung heroes in the world of care are the carers. I echo the call of the noble Baronesses, Lady Pitkeathley and Lady Wheeler, for the carer strategy and the action plan, long promised and long overdue. These carers are selfless family members or friends, who often work without help, payment or support, rarely getting respite.
The carer’s allowance, for those who take it—a lot of people are not even aware that there is an allowance that carers can take—is £3,260.40 a year. The winter bit is that there is a £10 Christmas bonus. I wonder: do we value our carers? Your Lordships will know, because  the noble Baroness, Lady Pitkeathley, reminds us on a regular basis, that were this huge army of carers to be paid just the living wage, it would cost the Exchequer much the same as the annual national health and social care budget. That is their value, but what are they worth?
Recent research shows that more than half of us believe that we do not know a single family member or friend who cares, while as many as three in five believe that they do not know any work colleagues who help look after a loved one. In reality, one in 10 people in the UK are carers and one in nine people in the workforce are juggling their paid job with unpaid caring. I remind the House that the Care Act calls for carers’ needs to be assessed alongside the needs of those they support. Could the Minister tell the House when the most recent report on this was published? Is this being met right across local authorities? When would he expect the next one, so we can measure improvement?
The solution to many problems is more money. More money can mean more staff and new preventive ideas. It could ease the way for primary care and community care to work more coherently with local social services. I acknowledge that more money has been made available to the care and health systems over the winter period. The better care fund increased social care funds by £4.4 billion over three years, as well as the adult social care support grant of £240 million in 2017-18. But work needs to be done in many parts of the country to improve existing systems—to look into data sharing between health and care as a matter of urgency, for example.
Before I address delayed transfers of care, I will talk about the reduction in social care support. Social care budgets have seen an estimated loss of more than £6 billion since 2010. Between 2010-11 and 2014-15, spending on social care fell by 7% even as demands increased over the same period. The social care precept allowed local authorities to raise council tax by up to 2%, and in December 2016 this was raised to 3%, but, as my noble friend Lady Pinnock and the noble Lord, Lord Smith of Leigh, explained, this tax is inherently regressive in its structure. Local councils in poorer areas are not able to levy an effective council tax as easily to meet social care demands.
Cuts to local authority funding, rationing and a reduction in the level at which support is available have reduced the number of care packages. This will invariably increase the likelihood that someone will become frail and so, when falling ill, will need hospitalisation. If care packages can enable someone to look after themselves, they often avoid going into hospital. Ironically, often self-funders fail to pay for as much support as they need. They can find themselves less able to self-manage and find themselves admitted.
There are financial and physical costs of the delayed transfers of care. The estimated annual cost to the NHS is around £820 million each year and the loss of 1.15 million hospital days in acute treatment—up 31% compared with 2013. There are physical costs. Each additional day in hospital is a higher risk of infection and rate of readmission. The amount of strength lost per day in hospital—I am talking about muscle strength of an elderly person—is up to 5%. Delayed transfers of care seem to hurt twofold: once on the bed  shortage, but again on muscle loss. If elderly patients lose up to 5% of their muscle mass daily and constitute the majority of patients under delayed transfers of care, the NHS could indirectly be contributing to a number of falls and hip fractures in the long run.
A lot of delays are attributable to the NHS, with 58.3% of all delays in November, compared with 34% to social care, and 7.6% jointly, with social care’s share slightly falling over the last year. The noble Baroness, Lady Watkins of Tavistock, spoke about the primary reason for social care delays—35.4%—being due to patients awaiting the care package in their own home. Will the Minister explain why there is not enough capacity in the system? Could this be due to a fall in private investors who no longer see this as a good investment? What is the solution? We all know that local authorities have responsibility for market shaping, but what if the market does not wish to be shaped? Where do we find ourselves then?
I shall put in a plug for the local community hospital. Those in my own backyard in Cornwall, having been saved from cuts in 1996 in advance of the 1997 general election—I remember Frank Dobson coming down and waving his magic wand—are now coming into their own as a safe place to transfer patients to when they no longer need medical care but do need nursing and rehab. Additionally, they are a resource for the GP, who can admit a patient for as short a time as a few days to see them over a crisis, rather than have them go into the local acute hospital.
Integration of health and social care is the holy grail of care. We watch with interest devo-Manc, where there is a commitment to integration of health and care, and Cornwall, where there is a move to make the CCG a department of the council. We should also note that Torbay has been working for years like this, now under the auspices of the Torbay and South Devon NHS trust, which states that it provides acute health services, community health services and adult social care. It is not rocket science; others have done it.
I was surprised, and then on reflection pleased, that the Department of Health was to be renamed the Department of Health and Social Care, despite the fact that the Secretary of State has always had responsibility for social care albeit with the support of a Care Minister. However, I am disappointed that, since Mrs May became Prime Minister, the Care Minister has not been a Minister of State—what message does that send us? That particular Minister of State historically has also looked after mental health. Those are two areas where you need somebody with a bit of oomph in the department.
In the first week in January, an article in the Financial Times written by Sarah Wollaston, was headlined:
“Only political courage can save Britain’s health service—It will take a cross-party approach and a willingness to put public interest first”.
Along with others, we on these Benches eagerly await the Green Paper on social care funding and ask the Minister what other topics will be in it. Will it become a portmanteau paper?
But do the Government have the willingness? My honourable friend Norman Lamb visited the Prime Minister along with Liz Kendall and Sarah Wollaston to ask for her support in this cross-party look at the  issue. They also asked her to consider raising income tax by a penny in the pound, which would raise £6 billion, which is the gap between where we are and where we need to be financially. Indications suggest that the public would warm to the idea. They see the system creaking and feel it is the least they could do. Those of us on these Benches agree.

Lord Hunt of Kings Heath: My Lords, it is a great pleasure to respond to my noble friend’s debate. As my noble friend Lord Smith mentioned oral health in the north-west, I remind the House that I am president of the British Fluoridation Society, which of course is the answer, at a stroke, to the dreadful oral health issues among children in Greater Manchester and the north-west generally.
My noble friend Lady Wheeler made a persuasive speech about the pressures that the NHS is under and the relationship between that and front-line social care. The latest figures on performance graphically illustrate this: in 2017, 16.5% of patients spent more than four hours waiting for treatment compared to 5.6% in 2012. On delayed transfers of care, there were 1.97 million delayed days in the first 11 months of 2017 compared to 1.26 million in the equivalent 11 months of 2012. The 18-week referral-to-treatment target for consultant-led treatment has not been met since March 2016. The 62 days from referral to treatment target for cancer has been met for only one month since April 2014. The number of cancelled operations is going up, as are ambulance response times—the new target of seven minutes for life-threatening calls was not met in its first month of operation. Occupancy levels in hospitals have become a hugely difficult issue. On 2 January this year, 57 of 137 trusts had bed occupancy above 98%. That means not just pressure but almost certainly unsafe practices in those situations. The Secretary of State, who has made quite a lot of noise about safety, needs to take stock of his own responsibility for the fact that there are now some very critical situations in the NHS where undoubtedly patients are vulnerable.
If the Government were at least open about this, we could have a proper debate, but, as the noble Lord, Lord Kerslake, said in quoting Chris Ham—who knows a thing or two and goes back quite some way—it is the Government’s denial about the scale of the problems faced that makes it so difficult to debate with them and have any meaningful discussion about the way forward. I think all noble Lords agree with my noble friend Lady Pitkeathley that the NHS crisis is also a crisis of social care. The information we received from the Association of Directors of Adult Social Services, saying that 90% of councils are able to respond only to people with critical and substantial needs, is telling, because we know it means that we are storing up even more trouble for the future because we are not intervening at a stage where we could help people. The report that we saw from Age UK and the chair of the Malnutrition Task Force said that only 29,000 people now receive meals on wheels, down from 155,000 a decade ago. No wonder it is said that 1 million older people are starving in their own homes. That is the scale of the problem that we face.
The noble Baroness, Lady Wheeler, in talking about the experience of carers, really brought this home to us. As she said, emergency care and hospital admission and then discharge is a make or break time for carers and their families. People like her become carers for the first time when this happens. Despite all the guidelines and good practice, most discharges take place with very little notice, particularly when there is such pressure to free up beds to make way for patients who are waiting in A&E, on trolleys or, indeed, in the ambulance, waiting to be seen in A&E.
My noble friends Lady Pitkeathley and Lord Pendry talked about the impact of carers and the problems they face for their health. I hope the Minister will respond to this question: if we cannot produce a carers’ strategy, can we at least have an interim action plan? Let us not just hide behind a Green Paper, which, frankly, I do not think we will see for many a month, if at all. I suspect the problem is that the Treasury will not agree to any proposal that is not along the lines of that which Mrs May proposed during the last election, which caused such concern.
Capacity is a major issue. The pressure is increasing but NHS capacity is reducing. Could the Minister explain why that is happening? I should also like him to reflect on STPs. There was a time when all the answers to all the problems were to be in the sustainability and transformation plans, which then became programmes. We do not hear so much from Ministers about STPs now, but the health service is trundling on because no one has told it to stop work on them. We debated here a few months ago the west London STP, which is a remarkable document. Because financial balance by 2021 is the imperative, it is essentially taking a great deal of capacity out of west London and then saying that through heroic demand management, which we have never seen before, everything will be all right. Most STPs repeat this because, basically, they have been told by the regulators that they have to come up with a plan that meets financial balance. I do not think Ministers believe in them anymore, but they used to believe in them; they used to say that they were the answer to the problem—but everyone out there knows that they are pieces of fantasy, which will never be delivered. I pray in aid the National Audit Office report, which came out in January and said:
“Local transformation of care is being hampered by a lack of resources and ongoing pressure to make increasingly tighter finances balance each year”.
So they are reducing capacity, but not producing any investment to develop other services, which would then help to reduce demand on acute care. So there is no hope whatever of achieving anything that these STPs say they will do.
We then come briefly to the new role of the Secretary of State. Will the Minister explain what that new role is? He knows that his department has been responsible for social care for decades; he also knows that the Department of Health negotiates the adult social care vote, albeit that then goes through DCLG. So what is changing? Is the Department of Health now to have the money for social care and is that then to be ring-fenced as an allocation to local authorities? If not, has there been any change at all in the Secretary of State’s responsibilities? I think we ought to know.
I accept, and my noble friend Lord Smith and the noble Lord, Lord Kerslake, explained, that it is not simply a matter of having integrated health and social care budgets. First, you have to deal with the gap between free-at-the-point-of-use NHS spend and means-tested social care spend. Until you deal with that, integration is very hard to deliver at local level. Secondly, you cannot look at social care budgets without looking at the overall spend and discretion of local authorities. Adult social care is probably the biggest discretionary spend they have: if you start to intrude on what they can do, it is very difficult to see how local authorities have the flexibility at the moment to be able to manage the rest of the local authority responsibilities. This is not at all easy.
The noble Lord, Lord Macpherson, spoke very articulately about the pressures on government finance in general. He said we could do with better management and I agree: the system needs to be reformed. I also agree with my noble friend Lord Brooke about the way hospitals are run. The hypothecated tax, informed by the OBR and based on national insurance contributions, seems to be a runner. His point about retired people having to pay national insurance was very well made. I have just been re-reading, or glancing at, the book by the noble Lord, Lord Willetts, about intergenerational fairness. Reflecting on my noble friend Lord Desai’s willingness to increase taxes, which I agree with, it is very difficult to say to younger people, “We are going to increase your taxes to be spent largely on a service that provides for older people”, when you have the current benefits for older people. This is a controversial statement to make from this Dispatch Box, but inevitably this has to be confronted. I am hoping to join my noble friend in being sacked at this point.
I come back to the report by the noble Lord, Lord Patel. It is a very good report, published on 5 April 2017. “How long, O Lord, how long” before we get a response from the Government?

Lord O'Shaughnessy: My Lords, I begin by congratulating the noble Baroness, Lady Wheeler, on securing this debate and bringing very welcome attention to the interaction between the NHS and social care systems. I am of course speaking on behalf of the newly minted Department of Health and Social Care and I promise that a focus on service integration is one that the Secretary of State and I, as well as Caroline Dinenage—who is Minister of State for Care, just to clarify that question—welcome and embrace. That is not, as we have discussed today, solely to deal with the winter pressures the NHS and social care systems face, but in order to provide a truly world-class health and social care system. Before answering the question that the noble Lord, Lord Hunt, asked about social care policy, this means that the department, through the Secretary of State and the Minister of State, are driving the reform process through the Green Paper, which was previously under the control of the Cabinet Office.
I congratulate all noble Lords on their contributions. I fear that there is sometimes a tendency in these debates—rightly, because we all want to solve  problems—to focus on negatives. It was good to hear from the noble Lord, Lord Brooke, and I hope that the family member concerned is in good health now and having a positive experience of their care, even though the situation he describes is rather alarming; it is certainly something I shall look into. We know that the vast majority of care being delivered is of a high quality and of course, that is because of the wonderful health and care staff to whom we all owe so much.
I start where the noble Lord, Lord Desai, started—in the less controversial part of his speech—by recognising that many of our challenges stem from the fact that people are living longer, which of course is very welcome. It is a global phenomenon: worldwide, the population aged 60 or over is growing faster than all younger age groups. In developed countries the proportion of the population aged 65 and over is expected to rise by 10% over the next 40 years. What that means in England is that by 2026 the population aged 75 and over is projected to rise by 1.5 million, from 4.5 million to 6 million, and by 2041 to have nearly doubled to 8.3 million.
Funding social care and health services is of course a challenge that all developed countries face. One issue, as we have said, is longevity; the other is the likelihood of multiple health conditions. An arresting fact is that by 2025, the number of older people living with a disability could increase by 25%, while the number of people with dementia will increase by 50% over the next 10 years. That is one reason why the solutions we come up with in the social care system need to deal with some of the arbitrary distinctions in the way that older people with different conditions get dealt with by the current set-up.
As noble Lords have pointed out, that inevitably means that we must change the way we provide services. The traditional model of healthcare was reactive, set up to deal with infectious diseases. Now, we are dealing with long-term, complex conditions that incorporate not just physical illness, but mental illness, as the noble Baroness, Lady Hollins, pointed out. Equally, the traditional model of social care relies on admissions to care homes, whereas we know that people increasingly want that care to be delivered in their own home. That in itself brings challenges, as the noble Baroness, Lady Watkins, said regarding loneliness and that horrifying statistic of older people suffering malnutrition in the home. These traditional models need to change. They are expensive and tend toward silo working. We need to move to a system in which care is individually tailored to people’s needs.
I will come on to talk about winter, but I want to address the situation regarding social care funding, which has been the topic of so many noble Lords’ speeches today. We know and admit that local authority budgets have faced pressures in recent years. They account for about a quarter of public spending and they had to play their part in dealing with the historic deficit inherited by the coalition Government in 2010. That meant that social care funding was inevitably impacted during the last Parliament, but with the deficit under control, we have turned a corner. There were two Budgets last year. In the March Budget, the Government announced that councils in England would receive an additional £2 billion for social care over the  next three years. I understand noble Lords saying that is not enough, but it is important to recognise that that, combined with other measures, gives councils access to over £9 billion over three years in dedicated funding for social care. That gives local authorities the ability to increase spending on adult social care in real terms to support and sustain a more diverse care market. As noble Lords have pointed out, that is incredibly important. The 2014 Care Act places obligations on local authorities and this extra funding is designed to enable them to meet those standards. The funding will also inevitably help to ease pressure on the NHS, including—as many noble Lords have pointed out—by supporting more people to be discharged from hospital as soon as they are ready. That is always important for patient welfare and safety, but never more so than at this time of year.
Winter is always challenging for the NHS in all four countries of the United Kingdom—not just this year, but in other years too. That is of course because cold weather and an increase in flu and other viruses place additional demands on the service. This year, preparations began earlier than ever before. I quote Sir Bruce Keogh, NHS England’s national medical director, who said:
“I think it’s the one that we’re best prepared for. Historically we begin preparing in July/August. This year we started preparing last winter.”
I was pleased to hear the noble Lord, Lord Kerslake, recognise that that preparation—as called for by the right reverend Prelate the Bishop of Carlisle—had taken place. Of course, that means we need to start preparing for next winter now; and indeed, we are.
Ahead of winter, NHS England and NHS Improvement also asked international experts from five leading countries to review how well prepared the NHS was for winter. They complimented the NHS on its state of readiness. In practical terms, they meant that just before Christmas—on Christmas Eve—bed occupancy had been reduced to 84%, helping to free up capacity to deal with the increased demand on services seen following the new year. Similarly, as my noble friend Lady Eaton pointed out, the 20% reduction delivered by local authorities has freed up over 1,400 beds a day.
I should also take this opportunity to reiterate the apology made by the Prime Minister for the cancelling of elective care. It was a difficult but planned-for decision to deal with extra demand as it arose. I should also emphasise that it did not include urgent treatments or treatments related to cancer.
Noble Lords will I hope know, as we have discussed it before, that there has been an unprecedented system-wide push on flu vaccination, including an expansion of the winter GP and national pharmacy programme. For the first time, workers in care homes have been able to access the vaccine free of charge. This has meant over 1 million extra people have been vaccinated, with the highest ever uptake among healthcare workers at 59.3%.
We know that doing things efficiently is one approach but we also know that more money is necessary. The Budget provided an extra £337 million-worth of funding for winter. The noble Baroness, Lady Wheeler,  challenged me on whether that money came too late. It is important to point out that at least half that money went to fund plans that were already in place. It is simply not the case that it could be implemented only once it had arrived. I should also point out that as, the noble Baronesses, Lady Wheeler and Lady Barker, and others asked, NHS England will at Easter be reviewing the impact of all the funding and the measures it took to deal with winter. The consequence of that funding is to have helped the NHS to open over 1,300 beds in December. That is on track to rise to 2,700 in February; the latest data shows 3,000 additional beds have been made available since the end of November.
However, I recognise that the preparations and investment have not fully been able to mitigate the enormous pressures on services, including ambulance services, and that in some cases this has led to unacceptable care being delivered. In particular, the rate of flu in hospitals is higher than the peaks reached in the previous seven seasons. The latest data in December showed that emergency admissions had risen by 4.5% compared to last year, so services are extremely busy. Despite that, the NHS treated 55,328 patients every day in A&E within four hours in December—over 1,200 more every day compared to the previous December. Let me use this opportunity to pay tribute again to the incredible work that our NHS workers do in emergency departments across the country.
As the noble Baroness, Lady Barker, reminded us, there have been many well-meaning actions by successive Governments over the years intending to improve our health services, but they have sometimes got in the way of delivering a truly joined-up system. I believe we all know and agree that the only sustainable solution to short and long-term pressures on the NHS is the integration of health and care services. That is the goal set out in NHS England’s five-year forward view, which this Government endorse. Integration is already happening on the ground. Now in its third year, the better care fund is a mandatory, national programme for integrating health and social care, which joins up services so that they are designed around people’s needs and enabling them to manage their own well-being, and to live as independently as possible. By mandating the pooling of funds, the better care fund has helped to join up health and care services, and to incentivise local areas to work together, with increasing amounts of funds used within this process.
The challenge now, which all noble Lords alluded to, is that we need to take that model and spread it into all corners of the health and care system, taking advantage wherever possible of the huge potential of technology to transform the way that care is delivered. The noble Baronesses, Lady Watkins and Lady Jolly, made suggestions about particular pilots and the use of community hospitals for integration. Schemes such as the vanguards scheme and new models of care are doing that, but I shall certainly take away their ideas and write to them to see whether we could do more to hasten that  integration.
We all acknowledge that the health and care systems have to work collectively to transform themselves for the future, both in the interests of patient care and to  put the system on a financially sustainable footing. The key process for delivering that is through the sustainability and transformation programme. The noble Lord, Lord Hunt, asked whether we were still as committed as we were before to that programme. I can promise him that we are and that it is now evolving into the creation of accountable care systems, which bring every actor in the local area’s health and care system together to deliver the kind of care that we want to see. That was backed by significant capital funding in the Budget.
The first group of designated accountable care systems have agreed to deliver their fast-track improvements as set out in the next steps on the five-year forward view, including taking the strain off A&E, investing in general practice to make it easier to get a GP appointment, and improving access to high-quality cancer and mental health services.
We know that the burden of care cannot simply continue to fall on hospitals. We need to move care into the home and the community. It was instructive to hear from the noble Lord, Lord Smith of Leigh, about how Wigan, as part of devo-Manc, is taking the lead in that initiative. Service integration needs to be underpinned by a joined-up workforce, as many noble Lords have said. That is why it is welcome to see the draft workforce plan launched by Health Education England. It includes the social care workforce, recognising the interdependencies between the two workforces. Many noble Lords, including the noble Baronesses, Lady Watkins and Lady Barker, asked about total staffing numbers. It is a topic we talk about a lot in this House, and I hope they will welcome the increase in training places for doctors and nurses. I should point out to the noble Lord, Lord Smith, that it also includes increased training places for emergency doctors.
I turn to the social care Green Paper. I use this opportunity to reiterate the Government’s commitment to publish a Green Paper by the summer of this year setting out its proposals for the reform of social care. It will be broad in scope and will look at the full range of issues relating to older people’s social care. To answer the noble Lord, Lord Pendry, it is intended to lead to a lasting solution. In developing the Green Paper, it is right that we take the time needed to debate the many complex issues, listen to the perspectives of experts and care users and try to build consensus, which has too often eluded us, so that the reforms can succeed. I look forward to engaging with all noble Lords in that process to take advantage of the golden opportunity to achieve lasting reform, as the noble Lord, Lord Pendry, said. The Green Paper will include action on carers. Many noble Lords asked about that. There will also be a carers action plan. I am not able to give a date on that, but I will write to all noble Lords when I am able to do so.
As well as reforming care, we also understand that the NHS needs to change. The Secretary of State for Health and Social Care said that,
“as we come to the end of the five year forward view, we need to seek consensus on the next stage for the NHS. We will need significantly more funding in the years ahead, and we need to build a national consensus on … that funding”.—[Official Report, Commons, 10/1/18; col. 346.]
The Secretary of State’s view is that we should try to do that for a 10-year period, not a 5-year period. He is clear that he is open to all discussions with colleagues about the best ways to do that. I know that he is making that case in government, but we are clear that NHS spending will continue to rise to meet the demographic challenges that we face.
The noble Lord, Lord Macpherson, provided some interesting and well-considered ideas, which were backed up by the noble Lord, Lord Desai, and others, about how things could change. We can and must speculate about different ways of raising revenue for various spending priorities. Of course, taxation is a matter for the Chancellor and the Treasury, but the last Budget shows that when we have been given the opportunity to increase funding for the NHS, we have done so. Indeed, the proportion of public spending taken by the NHS has been increasing over time.
Building a sustainable health and care system will require some big and urgent decisions, but getting this right promises a better service, where people understand their responsibilities, can prepare for the future and know that they will receive care of a high standard that will help them maintain their independence and well-being. We need to create a consensus, by whatever means, in this country behind a plan for change. That has eluded too many Governments in recent years. I hope that, when the chance comes, all noble Lords will make available their expertise and wisdom so that we can deliver a health and social care system that is truly fit for the future.

Baroness Wheeler: My Lords, I thank noble Lords for their thoughtful and wide-ranging contributions. I am not going to deal with them in detail because we want to move on to the next debate. I hope the Minister will write to noble Lords in response to the questions he has not been able to deal with and that he will draw the attention of the Secretary of State for Health and Social Care to everything that has been said today.
Motion agreed.
Sitting suspended.

NHS: Cancer Treatments
 - Question for Short Debate

Baroness Jowell: To ask Her Majesty’s Government what action they are taking to evaluate innovative cancer treatments and make them available through the National Health Service, and to raise life expectancy for cancer patients.

Baroness Jowell: I begin by extending my deepest gratitude to everybody who is giving their time to attend the debate this afternoon, and to contribute to something that will begin to reshape the way we think about the treatment of cancer for people all over the world. In doing so, I thank the noble Lords, friends and colleagues who have shown me such support  since I learned that I had a brain tumour. Today, though, is not about politics but about patients and the community of carers who love and support them. It is of course about the NHS but it is not just about money. It is about the power of kindness, support for carers, better-informed judgments by patients and doctors, and sharing access across more and better data to develop better treatments.
I shall briefly tell your Lordships what happened to me. On 24 May last year I was on my way to east London to talk, not for the first time, about new Sure Start projects. I got into a taxi but I could not speak. I had two powerful seizures. I was taken to hospital. Two days later I was told that I had a brain tumour—a glioblastoma multiforme, or GBM. A week later the tumour was removed by an outstanding surgeon at the National Hospital in Queen Square. I then had the standard treatment of radiotherapy and chemotherapy. To put it in context, across the country GBM strikes fewer than 3,000 people every year. It generally has a very poor prognosis.
Less than 2% of cancer research funding is spent on brain tumours, and no new vital drugs have been developed in the last 50 years. A major factor in survival is successful surgery. The gold standard is to use a dye to enable the surgeon to identify the tumour precisely, but it is available in only about half the brain surgery centres in the UK, and it must of course be extended to all of them.
Cancer is a tough challenge to all health systems, particularly to our cherished health service. We have the worst survival rate in western Europe, partly because diagnosis in cancer is too slow. Brain tumours, in particular, grow very quickly, and they are very hard to spot.
However, there is a good reason for hope. It is called the Eliminate Cancer Initiative. Its director, along with his great colleague who is travelling with him, is here with us today, one of the greatest men in the cancer field: Professor Ronald DePinho from the MD Centre in Houston. ECI is a global mix of programme and campaign, already under way in Australia. It is designed to be rolled out next in the UK, the USA and China. It recognises that no one nation can solve the problem of GBM on its own. It is an opportunity that belongs to the world.
ECI aims to do three main things: first, link patients and doctors across the world through a clinical trial network; secondly, speed up the use of adaptive trials; and thirdly, build a global database to improve research and patient care. Usually, drug trials test only one drug at a time. They take years and cost a fortune to deliver. New adaptive trials test many treatments at the same time. They speed up the process and save a lot of money. We can see approaches to the delivery of cancer treatment transformed.
ECI also has a secure cloud platform—it sounds rather technical, but you will very soon understand its importance—where doctors can share insight and data. Too much data is held in silos with highly limited access. That reduces its value. This is quite a new approach. Already, collaborative discussions are under way in England. ECI will focus on GBM because it is so tough to beat. It is all about sharing knowledge at  every level between everyone involved. If we achieve this, we will go a long way to crack GBM and other cancers.
For what would every cancer patient want? First, to know that the best, the latest science was being used and available for them, wherever in the world it was developed, whoever began it. What else would they want? They need to know that they have a community around them, supporting and caring, being practical and kind. While doctors look at the big picture, we can all be a part of the human-sized picture.
Seamus Heaney’s last words were, “noli timere”—do not be afraid. I am not afraid. I am fearful that this new and important approach may be put into the “too difficult” box, but I also have such great hope. So many cancer patients collaborate and support each other every day. They create that community of love and determination wherever they find each other, every day. All we now ask is that doctors and health systems learn to do the same, and for us to work together, to learn from each other.
In the end, what gives a life meaning is not only how it is lived, but how it draws to a close. I hope that this debate will give hope to other cancer patients like me, so that we can live well together with cancer—not just dying of it—all of us, for longer. Thank you.
[Applause.]
That belongs to all of us, so thank you very much.

Lord Blunkett: My Lords, this is the greatest privilege, and one of the most daunting moments of my life—to follow my noble friend, with the eloquence, the care, the compassion and the courage she has shown. She is my noble friend—not by affiliation or values, although we share them—but through a lifelong friendship that has lasted for well over 40 years.
If the House will forgive me, I want to say a word about Tessa—the noble Baroness, Lady Jowell—as a person. We got to know each other when we both chaired our respective social services committee. That is when I saw to begin with her care and compassion, described so well this afternoon. It is a compassion that has overcome the challenges that she faces and those of her family. Yesterday on the “Today” programme, and she said it this afternoon about the community of care, it was not just her own courage that shone through; it was the deep love and affection of her family—David, Jess and Matthew, and her extended family. The care she displayed this afternoon reached out, because it is the caring family and the community around those with cancer who travel on the journey as well. It is the love and hope that they give that reaches out.
Sally, the young mother on the “Today” programme yesterday, as with the experience of the noble Baroness, Lady Rebuck, whose husband Philip I knew well and saw just three days before he died, displayed the search for excellence, for innovation and, above all, for action, that my noble friend has called for this afternoon.
I know absolutely nothing about the ECI—but I will. There is a need to set aside bureaucracy in terms of the experimentation that patients who are on this   journey wish to try, to set aside the usual processes and to share the best practice from wherever it comes. Part of the role of family is to enable people to be able to sustain themselves while they seek access to that innovation and that improvement, and to know about where excellence exists here and across the world. Who you know is so often—too often—the telling point when you are seeking the best that exists in scientific development. What my noble friend Lady Jowell, my friend Tessa, has said this afternoon is that this should be available whoever you know, wherever you are and whatever access you have had to other people’s knowledge. The breakthroughs across the world need to be made available as quickly and with as little bureaucracy in our health service as possible.
My noble friend mentioned 24 May last year, when she was on the way to a Sure Start programme. She and I—when she was the first designated Public Health Minister and I had education and employment—started the Sure Start programme. We both went on a journey through to Cabinet—she exemplified her own wonderful networking skills in helping us to win the Olympics for London and their implementation, which shone across the world, and I had all sorts of different guises, good and bad. That journey has, for Tessa, my noble friend, always been about support, care and reaching out to others. When terrible terrorist attacks have taken place, not just here but across the world, she has cared about those families, just as her family now care about her. We are, all of us, privileged to be here this afternoon and to have heard her speak. She has given us a clarion call to pick up that cudgel and work tirelessly to ensure that what she seeks is carried forward for others in the future, and that our NHS, our scientists, our innovators and our consultants can draw down on the experience from across the world and can remember Tessa Jowell as we all will, and who we are privileged to have heard this afternoon.

Lord Falconer of Thoroton: My Lords, there is a lot of skulduggery in politics. Tessa said that this was not about party politics. It is not about party politics, but it is so much about politics. Looking to my left and to my right, I see every Labour Peer I have ever met—and a large number I have never met. Looking further to my left, I see innumerable Members of Parliament and, looking to the Public Gallery, I have never seen it as full as it is today. Every one of them is a friend or a member of the family of Tessa Jowell. In the decades that I have known her, she has done what everybody in the country wants their politicians to do—to earnestly follow noble causes and to try to make life better for other people. Tessa has been doing that in every way on every day for years and years.
These last months, for Tessa, have not been easy, but three things shine out. First is the extent to which she has touched other people’s lives. She has had masses and masses of correspondence from people she has helped. Just one sticks in my mind. It concerns a journalist she had met when she was Secretary of State for something. The journalist was having trouble, having just had a baby. Tessa went to a far part of south London—I apologise to the people of south London—just  to see the journalist and offer her assistance in relation to bringing up her new baby. That was absolutely typical of Tessa.
Tessa said that we should try to bring some kindness into politics. That is what she has done all along. There is so much to go with Tessa. She is going to make such a difference in what happens in the world. When the test of character came for Tessa on 24 May 2017—and, my goodness, it came—my goodness me, she passed it.

Baroness Neville-Rolfe: My Lords, I would like to congratulate the noble Baroness, Lady Jowell, on arranging this debate, and express my extreme admiration for her brave and moving speech. It is an honour to be able to add praise for all she has done and for the battle that she and her family have fought. As a result of her efforts, I believe that she will help many in the future who are less fortunate than her.
My younger sister died of cancer last year. She was a successful novelist with a great capacity to make friends and an extraordinary knowledge of culture and languages. But she had a pain and she did what so many women do, which was to struggle on and delay seeking medical help, with fatal consequences. In spite of the brilliance of the doctors in Dartmouth, New Hampshire, she died within two years of her first pain. So I am speaking today not only to commend the noble Baroness, Lady Jowell, but to encourage everyone to seek medical advice in such circumstances, and to endorse the Government’s scheme for referring possible cancer cases to hospital within two weeks.
Since I have a business background, I want to make two other points. The first is to commend the pharmaceutical sector for its many breakthroughs. Of course university research and development is critical, and we have an extraordinary share of Nobel Prizes in this country, but we also have great firms: AstraZeneca, GSK and smaller innovative sisters which apply capital and data, do trials and create a business model that can help millions of patients and shareholders—for example, our pension funds. These businesses have a real role in the task of finding innovative solutions for hard-to-tackle cancers, including brain cancer, which we are discussing today.
The second is to highlight the role of business-focused corporate responsibility. When I was at Tesco, we created a partnership with Cancer Research UK called Race for Life. Every year we organised 200 or 300 races in parks across Britain, with a lead event in Battersea Park. I ran it 11 years on the trot. They were amazing experiences, with women young and old, from our checkout to David Cameron’s office. There was always a splendid turnout of MPs and leaders like Helen Alexander, who sadly died of cancer herself last year. And there was always a bevy of Baronesses to add a touch of class and shed a few pounds, and some of you are here today. That was fun, but the important thing is that we raised a vast amount of money for Cancer Research UK—over £400 million in that period—and we increased the salience of cancer research through our TV ads and promotions. And on the back of every runner was scribbled a message about a friend with  cancer, or a friend who had died of cancer—a very emotional experience. In that era cancer recovery rates accelerated. We were in the right place at the right time. I wish the noble Baroness’s campaign similar success.

Baroness Rebuck: My Lords, I, too, thank my noble and utterly inspirational friend Lady Jowell. Very few people can take a personal challenge and transform it for the universal good with such courage, insight and compassion. She is a beacon of light and purpose to us all, and I thank her from the bottom of my heart.
My remarks are based on personal experience, as my late husband, Philip, Lord Gould of Brookwood—a great friend and a tremendous admirer of my noble friend Lady Jowell—died of oesophageal cancer in 2011. A routine test in 2008 showed an advanced adenocarcinoma and a 30% chance of survival. Chemotherapy had limited effect, and influenced by advisers—we have heard about that—and fortunate enough to have the means, my husband chose to go to New York for his life-saving operation. That was a mistake, and 18 months later the tumour returned in exactly the same place. Only then did we discover the oesophageal centre at the Royal Victoria Infirmary in Newcastle, and Professor Griffin, who undertook a very unusual second operation which extended Philip’s life by a year. But where was the accessible database highlighting this centre of excellence when we needed it most?
There have been precious few innovations in oesophageal cancer since, so we must harness digital development—accumulate and share research studies from our NHS and around the world—as the noble Baroness, Lady Jowell, advocates with the Eliminate Cancer Initiative. In the UK, interestingly, we have a resilient IT platform, Coordinate My Care—CMC—created by NHS clinicians for end-of-life care in London, putting patients’ experiences at the heart of its data collection. Doctors develop a personal healthcare plan, which is shared in real time with health and social care and emergency services. In the last year, five out of 10 seriously ill patients died in hospital in London, but for those on CMC it was less than two out of 10, with the biggest increase in those able to die at home, as they wished. If we genotype every cancer sufferer and do DNA sequencing on their tumours, as our Chief Medical Officer has called for, and if we ask patients to record every side effect on a simple app, by adding this phenotypic data to genotypic data we could—just imagine—have sets of priceless data and improve patient/oncologist consultations by providing a graph of reactions.
Most oncology teams are rightly focused on improving survival. Pain, nausea and bone marrow support are the main traffic lights for routine intervention. But patients with digestive system cancers, including stomach and colon cancers, all suffer other unpleasant side effects which can crush their spirit, leaving them debilitated and home-bound. A pioneering gastroenterologist at the Marsden who specialises in uncovering the cause of these symptoms and curing them was so essential to Philip’s quality of life that I fundraised for a proof of  concept trial which over the past two years found that nearly all patients responded positively to one of three inexpensive tests based on simple algorithms delivered by a trained nurse. The result: a better quality of life and better tolerance of treatment. Could this inexpensive intervention be introduced in relevant centres without a randomised trial?
Our marvellous NHS is overwhelmed and struggling to make the paradigm shift to personalised cancer care and take advantage of global research. A universal patient-centric database of genetic information, treatment and symptoms could be a bridge between the tried-and-tested protocols we currently depend on and the personalised medical programmes of the future, ensuring increased innovation and continuous improvement, which my noble friend Lady Jowell has called for. Perhaps Coordinate My Care could become a national programme, providing key data for her urgent vision of international medical co-operation.

Baroness Morgan of Drefelin: My Lords, I have joined this debate to pay tribute to the noble Baroness, Lady Jowell, for speaking out so bravely and powerfully on behalf of patients to promote faster access to innovative treatments for cancer patients, which is so desperately needed. I start by declaring my interests as the chief executive of the medical research charity Breast Cancer Now and as chair of the National Cancer Research Institute.
We know that research has led to huge improvements in cancer outcomes, particularly in breast cancer, the area I know best. We know too that, sadly, progress has not been uniform, and it has been woefully slow for some cancer types. This needs to change. As we have heard, it is time to do the really difficult stuff. Brain tumour research must be of enormous concern for the whole cancer research community, not least because, in addition to many patients with primary brain tumours, thousands of patients with breast, lung, skin and bowel cancer will develop metastatic brain tumours, reducing their life expectancy to single figures too.
Time is short and speed is of the essence. However, because we want patient safety and fair access for all, the system takes its time to assess the clinical evidence for, and cost effectiveness of, new treatments, then to negotiate deals with drug companies and then to work through the budget impact hurdles that treatments have to overcome. But patients need access to life-saving treatments now, and we are being left behind other similarly wealthy economies. Therefore, the system needs to change.
I believe that adaptive trials offer real flexibility that can benefit both patients and research, but there are challenges involved. This type of trial and other new approaches are becoming more accepted by funders and, crucially, by the regulators, who drive the methodology in these situations. This needs to be further encouraged, and there are other innovative ways of speeding up trials that can help too.
Innovative clinical trials are the key to faster access, but joining up data is vital too. On a very practical level, the NCRI is bringing together multidisciplinary  teams of researchers who are expert in clinical trials. They represent a unique resource for UK science. I am delighted that the latest new collaboration is to bring UK researchers in lung, breast and skin cancer together with brain tumour researchers to look at new opportunities. This would be a great chance to take forward the noble Baroness’s ideas.
Finally, innovation does not have to be expensive. For example, you would think that repurpose drugs could get to patients quickly but it is not so easy. I know that the Minister knows all about that and I look forward to hearing from him. Again, I congratulate the noble Baroness on speaking hope for patients.

Bishop of Carlisle: My Lords, it is a great privilege to speak in this debate. I begin by observing that although, as we have heard, we currently have one of the worst cancer survival rates in Europe, the overall 10-year survival rate for all cancers in the UK has improved from 25% a few decades ago to 50% today. The laudable and ambitious goal of our cancer strategy is to make that 75% within the next decade, thereby not only catching up with but surpassing international, and especially European, averages. Cancer Research UK, among other agencies, is currently researching possible therapeutic interventions, many of them innovative, in a range of more than 200 different types of cancer, and that is something to celebrate. However, I suggest that three vital conditions need to be met if those aspirations are to be achieved.
The first, as others have mentioned, is proper funding for research as well as for the highest-quality treatment available for all cancer patients. This is obviously a major challenge for an NHS which is strapped for cash and for a country which faces so many massive, competing demands for its resources. In the previous debate today, I and others referred to the recent report of the Lords Select Committee on The Long-term Sustainability of the NHS and Adult Social Care. I beg your Lordships’ indulgence to do so again now, as that report, which I hope we will soon be able to debate, directly addresses this issue.
The second condition is prioritising planning, especially of the workforce. Health Education England’s cancer workforce plan talks about training 300 more endoscopists and 200 more radiographers, and about every patient having access to a cancer nurse specialist by 2021. That is most encouraging but it has to be seen in the context of a significant shortage of staff trained to perform tests necessary for diagnosing cancer and alarming forecasts about future vacancies. For instance, 28% of radiographers are due to leave by 2021. The APPG on cancer concludes that NHS England will struggle to achieve the objectives set out in the cancer strategy unless corrective action is taken immediately—and that includes taking the NHS out of party politics in order to encourage long-term plans.
The final condition is putting patient outcomes ahead of process target performance. This is essential for identifying treatments for inclusion within the NHS. It also applies to the release of funding, both for early diagnosis and support for life after treatment.  Several cancer care alliances have had their funding delayed because of their lack of progress against the 62-day wait standard, and some genomic diagnostic testing is in danger of being withdrawn even though that may mean that thousands of cancer patients may have to endure what, for them, would be unnecessary and debilitating chemotherapy. Good patient outcomes include not only increased life expectancy through cure or slowing down the disease but the prospect of improved palliative care.
I welcome this short debate on innovative cancer treatments and, like everyone else, I am grateful to the noble and courageous Baroness, Lady Jowell, for securing it. I hope that its outcome will be another step forward for cancer patients everywhere.

Lord Turnberg: My Lords, it has been a real privilege to hear the noble Baroness, Lady Jowell, give such a brave and inspiring speech. I do not know how anyone cannot be very touched by her words. I have long admired her and now more than ever see her as an inspiration. The spirit that she demonstrated so clearly is absolutely characteristic of her. If I may be permitted a personal note, I love the hat.
The noble Baroness makes an impassioned case for the availability of new experimental forms of treatment, and who is there to gainsay her? Cancer Research UK says we need much more research to understand the nature of glioblastomas—and of course it is right too—but meanwhile what are patients to do? It is true that doctors are able to prescribe novel treatments for individuals on what is known as the named patient basis, and the Bill of the noble Lord, Lord Saatchi, a couple of years ago encourages that approach. However, the problem is that many such new treatments are specific for very small numbers of cancer patients and the costs are enormous.
That immediately brings us to the question of funding—we cannot get away from that. The late lamented cancer drugs fund was soon overwhelmed by the high costs of new diagnostics and drugs. The remarkable advances in so-called liquid biopsies, in scanning, in proton beams and in specifically tailored molecular therapies and immunotherapy are all extremely costly, and no amount of juggling with flexible pricing mechanisms and outcomes-based pricing will find the money needed. So I ask the Minister whether the Government will take note of the recommendation in the Select Committee’s report on the future sustainability of the NHS for a new method of funding involving a hypothecated tax system based on national insurance payments. I am sorry to be so controversial.
The average age of your Lordships’ House is 69. That means that almost half of us have or will have had one cancer or another. I have had two and I suppose, statistically speaking, that saves one other from having one. That makes cancer take on an intensely personal meaning for all of us and we are fortunate to live at times when so much more can be done for us than ever before. Unfortunately, it all comes at a cost and we could be doing so much better. As we lag behind in so many ways, in some cases we are complicit in failures that should just not happen.
I finish on a point about prevention, where we might be able to save someone. We have an extremely effective way of detecting women who are susceptible to ovarian and breast cancer. Here I express my interest as a recently retired trustee of the charity Ovarian Cancer Action. Testing for the BRCA gene, the gene responsible for passing on susceptibility, is now offered to close relatives of ovarian cancer patients, but a relative who is not quite so close, with a smaller chance—say 5%—of being a carrier, cannot have the test. If you have a one in 20 chance of carrying a gene such as that, would you not go for a test costing just £175? It is a bargain for the NHS. I ask the Minister: will the offer of such a test now be made to all such at-risk relatives?
Finally, the briefing I have had from Cancer Research UK suggests that our ability to conduct vital cancer research will be compromised after we Brexit from the EU if we cannot ensure the future of cross-border clinical trials, as has been spoken of. Will the Government ensure that we will be able to continue to collaborate seamlessly with centres in the rest of Europe after Brexit?

Baroness Finn: My Lords, I pay tribute to the noble Baroness, Lady Jowell, for calling such an important debate. She shows the dignity and courage in confronting her illness that have characterised her approach throughout her inspiring career in public life. It is typical of her selfless determination that, passion and energy undimmed, she is still fighting to ensure that everyone receives the best care.
Cancer is one of the most feared words in the English language. It represents a terrifying diagnosis. It is the number one cause of untimely deaths in Britain. Cancer has touched all our lives, and we should fully support anyone who wants to try an innovative drug or treatment. When confronted with dreaded words such as “malignant”, “inoperable” and “advanced”, surely any alternative that offers hope is better than none. There is another important reason to allow patients to take the risk of different innovative treatments. Quite simply, there will be no cure for cancer unless patients can receive them.
Many cancer patients talk of the wonderful care they receive from the NHS, but, as others have pointed out, this should not blind us to the fact that, of the top 30 countries that offer universal access to healthcare, the UK is in the bottom third for cancer survival.
Time is necessarily short, so I will make three brief observations. First, we fail to invest sufficiently in the early diagnosis of cancer. If caught early, the chances of cure and survival are dramatically improved. In some states in the USA, there has been a concerted effort to try to catch lung cancer with CT scanning and the pioneering use of keyhole surgery.
Secondly, the Government need to help transform a culture in the NHS that can be resistant to innovation. When a patient is handed a terminal diagnosis and only standard treatments that do not work, the patient dies, and so does any chance of finding a cure. We need to ensure that our remarkable NHS staff are  developed and empowered to adopt and interact quickly with the innovations that become available, both in the UK and overseas.
Thirdly, there needs to be a broader argument about the reform and funding of the NHS to put this on a long-term sustainable basis. My honourable and, indeed, very good friend Nicholas Boles, who has been cured of cancer twice, rightly praises the outstanding treatment he received from the NHS. He has proposed that the NHS should be given its own stand-alone funding stream, perhaps through hypothecated national insurance contributions. The debate is certainly urgent and long overdue.
To quote Dylan Thomas, from my native Swansea, most patients when confronted with terminal cancer and the possibility of dying do not want to go gentle into that good night. Like the noble Baroness, they want to focus on staying alive and take the risk of adaptive trials. They should be able to rage against the dying of the light by trying innovative treatments to keep their hope alive.

Baroness Dean of Thornton-le-Fylde: My Lords, I join other noble Members of this House in thanking sincerely Tessa, my noble friend Lady Jowell, for this debate. Rightly, people have talked about her courage. Those of us who know her know that she has had that for years. As a politician in the other place she would dare to tread where others would not even think of. I was pleased that the Sure Start scheme was mentioned, because it really is a legacy given to this country that has helped young children. So we are privileged today not only to have this debate but to have my noble friend Lady Jowell introduce it and speak from her personal experience.
I need to declare an interest: I am a trustee of University College hospitals foundation trust and was on the group that initiated what is now the Macmillan Cancer Centre, near the hospital. It took a lot of fundraising, but, linked with the hospital, we now have the proton beam therapy machine coming online, but it will not be until 2020. A proton beam therapy machine will come online at Christie’s in Manchester later this year. That is going to help. Since 2008, 400 of our young children have had to go abroad for treatment for cancer, because we have just not had the facilities in this country. Yet we are very good at making breakthroughs—the research, the innovation and all the rest of it. What goes wrong between that and touching the individual with cancer who needs help?
When we started that scheme, the statistics showed that one in three of us would suffer cancer during our lives. I gather that it is now one in two. It is a national challenge for us. As the noble Lord, Lord Turnberg, rightly said, it is not an easy one; it is quite difficult.
At the moment, we are trying to raise—it is almost peanuts—£0.75 million to buy a photodynamic therapy machine. In lung cancer, 60% of those who have pre-cancerous lesions in the lung go on to have cancer which is difficult, and in many cases impossible, to deal with. We are trying to raise the money to do that, and it is right that we should. As my noble friend said,  it is not just about National Health Service money; it is about somehow bringing together everything we can to fight what is the scourge of the world today. It is not just in Britain; it is an international situation. Somehow, we have to get the researchers, the clinicians and all the profession together to make sure that we can deliver what my noble friend has said. Her arguments are unanswerable. I hope that the Minister does not just give us a list of what the Government are doing now; we want to know what they are going to do to respond to this important debate.

Lord Freyberg: My Lords, less common and rare cancers account for more than half of all cancers, but each is a small individual market and so under-researched. Be they brain or, in my sister’s case, mesothelioma, they suffer a chronic lack of innovation. I therefore commend the noble Baroness, Lady Jowell, for her bravery and the moving way in which she has brought these important issues to the House.
This country has a globally unique research asset that could make a difference. It is the cradle-to-grave records inside the NHS. We are uniquely placed to supply the insights on what works and what does not. This large-scale, real-world information could revolutionise care and research, especially health economic evaluation.
Yet researchers cannot get access. Let me explain, with some examples. The Brain Tumour Charity has been trying to unlock this data for their patients, 97% of whom want their data to be used for research. They have written informed consent, yet they have been met with official obstruction at every turn. NHS Digital wants £100,000 a year. Public Health England wants £378 an hour, and for information that would be more than a year out of date.
The same challenges affect those developing cures. In a recent survey, more than 80% of UK biotech companies said that NHS data and patients are a unique asset for the UK life sciences sector. However, almost all said that access to these insights was near impossible given current processes and policy, and that they were forced abroad.
We want to see the NHS improve patients’ lives through innovation. We are all aware that there is no infinite money tree from which to pay for such innovation and, as a result, we need timely and accurate evaluation based on real-world insights from within the NHS on what works and what does not. It is important to stress that decision-makers and researchers generally do not need access to patient-level data; they need access to privacy-conserving statistical insights such as, “Is treatment A or B more effective?”. Statistical technologies exist to do this routinely, and at very low cost, yet they are almost unknown in the NHS, which employs armies of human analysts instead.
We must get the policy and investment on real-world research right if we are to make effective use of these assets. It does not require primary legislation, but it does require joined-up thinking across health, business and research, and careful management of various internal vested interests. The creation of Health Data Research UK provides a unique opportunity to drive such alignment. Therefore, I ask the Minister to commit  to using the life science sector deal to make this happen. Can he confirm the routine measurement of care outcomes in the NHS as his top priority, and clarify who will be in charge of co-ordinating and funding delivery for this critical cross-cutting agenda?
It has been a huge privilege to partake in the debate of the noble Baroness, Lady Jowell.

Lord O'Neill of Clackmannan: My Lords, it is customary with debates like this to congratulate the mover on being able to secure the time. I do not know whether that is appropriate today, but I should like to pay tribute to Tessa for the courage and dignity with which she has addressed this issue.
I would like to talk from a self-interested point of view about prostate cancer. The first thing that you are told when you are diagnosed with this is that more people die with it than of it—that it is manageable—but that presupposes that you have been diagnosed. The point that I want to dwell on today is that the process of getting diagnosed and being aware is something that men in particular are not very good at. There are many men in this House who are currently suffering from prostate cancer. We do not go to the doctor frequently enough; we are not used to being prodded and probed in the way that ladies are; and we do not like the idea of the test, although the truth is that there is nothing much to the test. Those who do not like it are just big fearties, as we would say in Scotland, and the ones who do like it are easily pleased.
The treatment that I have received and the support that my family have enjoyed from the Western General in Edinburgh since 2014 have been exemplary. But I am concerned about the fact that far too many men are unaware of the signs of the condition. Many of us take statins and hypertension drugs that result in us getting up at night. We do not realise, or do not wish to see, that that nocturnalism could be cancer related. Therefore, I would like two things to be considered by the medical profession and the authorities—first, that there be a far greater public awareness campaign on the symptoms of prostate cancer and, secondly, a more proactive approach should be taken by GPs when they are prescribing drugs with diuretic side-effects. Far too many men become aware of the significance of their symptoms when it is getting late or, sadly, too late, and when the treatment of the condition is a great deal more expensive and, on occasions, quite unpleasant—and, certainly, not always successful.
Once again, Tessa, I thank you for giving us the opportunity to raise this issue in the manner in which you have done today. It is not an issue for party dispute but a social concern for a medical problem which is still intractable. We are not going to solve it tomorrow, but if we can save more lives more quickly and make those whose lives cannot be saved that much more comfortable, we will be fulfilling a very useful function and offer a great deal of support to the families that are so afflicted.

Baroness Redfern: My Lords, I thank the noble Baroness, Lady Jowell, for initiating this debate  today—it is a privilege to take part and I thank her for her passionate, moving and very brave speech. I want today to support all cancer patients who wish to have the opportunity to be involved in clinical trials, as adaptive clinical trials are a promising way to develop new treatments by offering those patients multiple opportunities to test. Life expectancy has significantly improved but unfortunately in some cancer sites early intervention is more difficult; for example, as we have heard, brain cancer and pancreatic cancer, which my late husband suffered from. Those numbers are struggling to move. As we all know, cancer touches us all.
Today’s debate, however, brings attention to how important new innovative cancer treatments can offer life-changing outcomes. The NHS is working collaboratively with the life sciences sector to improve accountability and transparency in the take up of innovation with the support of NICE, and that has to be welcomed. The NHS enjoys the benefits of SME contributions: many of the companies in the UK life sciences sector are small and medium-sized companies, so I am pleased that financial support has been given, with the help of the new £6 million government scheme, together with £34 million over four years provided to encourage and support those innovators to develop world-leading digital solutions. A good, supportive research environment in the UK is needed to ensure that the best research can be carried out to speed up the development of pioneering treatments, with accelerating access to new medicines, benefiting from working with international collaboration on clinical trials: that must continue.
Flexible pricing mechanisms, such as outcomes-based pricing, would result in quicker decisions about approvals, with pricing based on a drug’s value to the NHS. Also, more emphasis must be placed on the genomic revolution to eliminate the one-size-fits-all approach to cancer treatment. I welcome NHS England’s steps to create a genomic medicine service to close the gap and ensure equitable access to molecular diagnostic testing for all patients across England. Good data sharing is paramount.
A cancer diagnosis can be, and is, frightening, distressing and confusing. As I said, it touches us all, whether it affects a loved one, friend or colleague. A much needed shift in emphasis towards prevention and a clinical strategy march of medical science, together with a strong media campaign, must lead to increased longevity. Finally, cancer patients throughout their treatment are focused on staying alive as long as possible, so it is important that they are free to take more risks. I thank the noble Baroness, Lady Jowell, for her brave speech: this is about giving hope for everyone, all patients; it is about improving the cancer campaign and improving outcomes.

Lord Hunt of Kings Heath: My Lords, I too thank my noble friend Lady Jowell for an extraordinary speech, full of passion, compassion and hope. I had the great privilege of following her as a Minister at the Department of Health: what a formidable reputation she had as our first Public Health Minister and what a legacy she left. Many of today’s public health programmes  which are taken for granted she established in those first two crucial years. I do not know whether she knows that I have not quite forgiven her for her other big decision at Richmond House, which was to get rid of chocolate biscuits and bring in fruit bowls instead. What she does not know is that a certain Minister of State not a million miles from where she is sitting had a secret cache of those biscuits—my noble friend Lord Hutton became very popular for having meetings in his own ministerial room.
My noble friend Lady Jowell has raised a huge question about access for NHS patients to innovative treatments. In a sense, that is the great paradox of health in this country. We have an NHS that we are enormously proud of. It is still very well regarded internationally. We have an incredibly strong life sciences sector, with over £60 billion of turnover and over 200,000 high-quality jobs. We have one of the strongest pharmaceutical industries in the world: 25% of all global medicine is developed in the UK. Then, as the noble Baroness, Lady Dean, and my noble friend Lord Turnberg said, we have the great paradox; it is a British problem too. We have this great development, this great invention, but we are slow to adopt it. The experience of my noble friend Lady Jowell and so many other NHS patients is the same. If we look other countries, such as Germany and France, we can see that their patients have much more access to innovative treatments than we do in this country.
When my noble friend was a Minister, she had the first discussions about the establishment of NICE, which was set up to deal with this British problem. It was calculated that it took 15 years for a proven new innovative treatment to be adopted generally in the health service. Here we are, nearly 20 years, still facing the huge problem of innovation adoption. It is true that the Government have established the accelerated access review; they also have a life sciences strategy, post Brexit. However, we have to do much more. Of course finance is important, but the Minister will know that it is not just about finance—it is about attitude. I hope that the one message he will take away from this extraordinary debate and from my noble friend is that we have to do better in the NHS to adopt the huge innovation that so often takes place in our country.

Baroness Hayman: My Lords, like the noble Lord, Lord Blunkett, I have known the noble Baroness, Lady Jowell, for over 40 years. We met as young women, trying to make our way in the Labour Party and change the world. I never dreamed that we would end up as ministerial colleagues at the Department of Health or, two decades later, as fellow Members of your Lordships’ House today. What does not surprise me is that my very dear friend has shown unfathomable fortitude and determination in her current illness, or that her enduring commitment to the public good has led her to scrutinise the care we provide to those who have cancer—particularly obdurate ones like her own—and to campaign for improvements in that care.
Following on from the words of the noble Lord, Lord Hunt of Kings Heath, I believe that the UK has tremendous opportunities to make progress, even given  the formidable challenges that these cancers present in terms of timing, precision of diagnosis and the development and evaluation of effective treatments. If we are to make that progress across the spectrum of prevention, detection, treatment and cure, we have to collaborate internationally. I hope the Minister will have some words to say about the EU clinical trials regulation that we expect in 2019. We also have to exploit all the resources we have; that includes the NHS and its scientific goldmine of information, which my noble friend has already referred to. That is one resource. Another is the Cambridge Biomedical Campus; I declare my interest as a recent chair of Cambridge University Health Partners. At that campus, we have world-leading research institutes, such as the Laboratory of Molecular Biology, Cancer Research UK and the Wellcome Sanger Institute, just down the road. We have great NHS hospitals: Addenbrooke’s now, and Papworth to come. We have leading international pharmaceutical companies, including AstraZeneca and GSK; and, of course, we have the University of Cambridge itself. The opportunities are enormous if these players can collaborate effectively.
There are exciting plans, led by Professor Richard Gilbertson, a world-leading expert in brain cancers in children, to build on the already impressive results in, for example, breast cancer, by creating a ground-breaking institute for early detection and a new cancer research hospital, bringing patients speedy access to the latest research and treatments. I hope the Department of Health will see this not as another simple NHS building project but as a real opportunity within the context of the life sciences strategy.
The noble Baroness, Lady Jay, cannot be here today as she is abroad. She asked me to say how sad she was to miss this opportunity and to pay some words of tribute to the noble Baroness, Lady Jowell. I think she would feel that the House has perhaps done her proud in paying that tribute. I started off by saying that, 40 years ago, Tessa wanted to change the world. The debate today illustrates clearly that her determination to do so is undiminished.

Baroness Goudie: My Lords, I thank my noble and very good friend Tessa Jowell, who I have been friends with for over 40 years, from our days on Camden and Brent councils and through many other campaigns for her to become a parliamentarian and so on. I find today’s debate on evaluating innovative cancer treatments very important.
Britain has a first-class reputation for research but, at the same time, we do not always manage to get the treatment to the patients as early as we should. A number of citizens from around the world want to come to Britain because they know that we have a good reputation for the research and treatment of cancer. It has to go further; there must be more sharing of research and data in Britain and around the world. This would save time and save lives. Travelling is tiring and dangerous for patients with cancer. We must have places of excellence in cities, so that people can at least get to them.
I would like to thank Athena Lamnisos, from the Eve Appeal, for her great work. I have worked closely  with her. The Eve Appeal is the UK national charity raising awareness and funding research into five gynaecological cancers: ovarian, womb, cervical, vaginal and vulval. It was set up to save women’s lives by funding ground-breaking research and is focused on early detection and developing effective methods of risk prediction, as well as developing screening for women-only cancers. It is vital that the health service continues to fund screening, which must be made more widely available. Many lives will be saved if cancer is detected early. In the same way as my noble friend described issues surrounding prostate cancer, women also must not be afraid to go for these tests.
I would also like to thank Vanessa Elliott, consultant at St George’s Hospital and Sarah Rudman, consultant oncologist at Guy’s and St Thomas’, who were very helpful to me in preparing for this debate. They thought that I would have hours to speak. I told them that it would be only three minutes, but they have been very helpful nevertheless. I hope that we will have a longer debate on cancer and the health service at some stage when I can talk at greater length. The Brain Tumour Charity and many others who contacted us all have explained how serious and important it is that cancer is dealt with as quickly as possible.
There are lots of imperfections in clinical trial design and the process could be improved. In oncology, they try to have good working relationships with pharma in order to be involved in the trial design process at the earliest opportunity. It is hoped that focusing on design will lead to a drug licence. Most of the time the pharmaceutical industry and clinicians are aligned, but not always. In general, though, the drug development process is still chunky. Traditionally, most trials still progress through phases 1, 2 and 3, which is expensive in terms of finance, nursing and doctors’ time and, importantly, patient effort. It is also time-consuming and may result in patients waiting too long for new treatments. We must ensure that when there are new treatments there is time available when patients are willing to experiment with those treatments.
In recent years, more innovative drug trials have been used in an attempt to reduce the length of the drug-development process. That is what can happen if we share around the world. It is important for patients also to have equitable access to the early phase of clinical trials. These trial units are often found only in large cancer centres, and not all patients have access to them. Well-enough patients who have exhausted conventional treatments and tumour-specific trials may want to access unlicensed drugs.

Lord Deighton: My Lords, my first experience of the courage of the noble Baroness, Lady Jowell, was watching her take on the Chancellor, Gordon Brown, to squeeze the Olympic budget out of him, which was as close as you can get to a combat sport. None of us who know her is in the least surprised that she should see her cancer challenge as an opportunity to help other people. I thank her for shining her very bright light on this subject and I am delighted to work with her again.
I shall basically talk about science. I believe we are at a pivotal moment in cancer research. That is why for the past year I have been very involved with Cancer Research UK, which has been referred to a few times this afternoon, trying to help it think through how to raise privately all the money needed to capture the enormous opportunity presented by the spectacular advances in science and technology. I shall give noble Lords some examples: the improvements in genomics, the ability to harness our immune system in treatments and our ability to visualise what is going on inside tumours. We can also apply all the new technology we have. This is when I say things such as “AI”, “deep learning” and “machine learning”, noble Lords all nod and we all know what we are talking about. It means that we can generate and analyse massive amounts of data in a hugely helpful way for big patient trials around the world.
Quite simply, the goal of cancer research, which is what we are thinking about, is to exploit scientific developments—this has been mentioned a couple of times today—to improve 10-year survival outcomes: from two out of four to three out of four people. That is a nice simple goal. To accomplish this, there are three particular areas of focus that I shall bring to noble Lords’ attention. We have talked about the first one already. Cancer Research UK will now devote much more money and meaningfully shift talent and infrastructure to tackle the hard-to-treat cancers such as brain tumours, as well as lung cancer, pancreatic cancer, which killed my father, and oesophageal cancer. As everybody knows, to date, research in these areas, compared with, for example, bowel and breast cancer, has been very low and very thinly spread.
The second key area of work is personalised medicine. Doctors need to be armed with a detailed read-out of the molecular faults in a patient’s tumour, and to be armed with a new generation of drugs that precisely targets them—no more hit-and-miss and wait-and-see. An enormous amount is happening on this all around the world, as was commented on. There are great new treatments and smarter clinical trials. There is a big opportunity to get them properly co-ordinated so that we can get the most out of them; the current approach is much too fragmented.
The final work that I want to talk about is really revolutionary and most captures the changes in science we need to exploit. It is what we are calling the grand challenges. These are very big research grants, aimed simply at solving the biggest problems—the ones that will change people’s lives. They are doing it by bringing together the best scientific talent from around the world and from across different disciplines and forging them together to attack the big problems. I am really optimistic that that will produce world-changing outcomes. Our aim is to raise all the money for this privately, really by conveying to potential donors that, because of the science revolution, the opportunity is huge and it is now, so give us your money. I apologise for practising my pitch here, but we need to work on it.
My request to my noble friend the Minister is not for money but simply to help preserve the competitiveness of the UK’s research environment. I will leave noble Lords with one thought. After we leave the EU, it is  essential that our future immigration system allows us to attract, recruit and retain global scientific talent at all professional levels, regardless of their nationality. That is my number one ask.
I once again thank the noble Baroness—my dear friend Tessa—for shining her light, and long may it continue.

Lord Giddens: My Lords, this has been a magical debate. I cannot remember anything quite like it in all my time in your Lordships’ House and I believe it will have a profound effect. I express my great admiration for my noble friend Lady Jowell: for her steely determination, her compassion and her humanity for other people. This debate will be seen in many different countries.
Quite a few years ago, the celebrated American biologist Stephen Jay Gould was diagnosed with mesothelioma, which is cancer derived from contact with asbestos. Doctors told him that he had only eight months to live—or that is what he thought they had told him, because this was the average survival period. He looked at this, as a statistician, and understood that what matters about an average is not just the average itself but the span of possibilities. He famously said:
“I am an optimist who tends to see the doughnut instead of the hole”.
He studied the evidence on survival rates, in a careful and sophisticated way, and his conclusion was that,
“those with positive attitudes, with a strong will and purpose for living, with commitment to struggle … and not just a passive acceptance of anything doctors say, tend to live longer”.
Stephen Jay Gould lived for 22 years after his diagnosis. Admittedly, this was through the supreme force of his will and his knowledgeability, but it shows that you must interrogate any diagnosis that is made. That is crucial; it was crucial for him. Moreover, his fame brought mesothelioma out of the shadows where it had languished for so long—a bit like with tobacco, there was a lot of industry resistance.
My glory was stolen a bit by the previous speaker, because I was going to conclude by saying that we are on the threshold of some of the greatest innovations ever made in medicine. These are coming very quickly. Why? Because of the algorithmic power of supercomputers; because doctors and medical researchers can share their research instantaneously across the world, which was not possible before the digital age; and because of linked advances in genomics and genetics. There is enormous hope. For example, the situation with myeloid leukaemia, which was thought to be incurable, is now quite different because of these research breakthroughs.
The main question to be asked of the Minister is the one that inspired the debate: will these breakthroughs be confined to the privileged few? The NHS is in the middle of a horrible crisis. The problems of the changing demographic structure of our society lie behind this. Will the Minister say, forcefully, that the treatment of relatively rare cancers such as brain cancer and mesothelioma will not suffer as a result of the situation in our health service, and that he will take direct measures to ensure this?

Baroness Walmsley: My Lords, this has been a unique, moving and effective debate. I am proud to be able to support the demands of the courageous noble Baroness, Lady Jowell.
In my three minutes I want to focus on two of her demands: early diagnosis and patient rights. Public Health England says:
“Diagnosing cancer earlier is one of the most important ways to improve cancer survival and we know that those patients who have their cancer diagnosed as an emergency have poorer outcomes”.
That is why new screening and diagnostic methods must be made available quickly.
In fact, I am standing here because of screening. I say to the noble Lord, Lord Turnberg, that I have had two as well; perhaps we should start a club. That shows how far we have come, does it not? Screening does not merely diagnose disease but can sometimes predict the risk of it through identifying gene mutations, as we have heard. Genomic screening can also contribute to treatment decisions by predicting how the tumour will respond to chemotherapy. That can avoid chemotherapy for those patients who will not benefit from it.
Diagnoses of colorectal cancer through the national bowel screening programme remain under 10%. This effective early diagnostic tool is not being used widely enough. Is that because CCGs are not offering the screening, or is it because people are not returning the samples? What are the Government doing to improve those figures?
I agree with the noble Baroness, Lady Jowell, that patients should have a great deal more say in the risks that they are prepared to take, and that adaptive trials should be allowed where they could help. I will not repeat many of the cancer-related examples that we are today, but I shall give the House a non-cancer example of where the system is preventing a patient from receiving medicines that have already been shown to work, to illustrate that the problems that the noble Baroness has identified go wider than cancer.
A small boy, whom I will call A, has rare and serious epilepsy. He was treated, at great expense to the NHS, with powerful pharmaceutical drugs to stop his fits, although some of them were not even licensed for use on children. His condition did not improve and the doctors admitted the drugs could damage his vital organs and shorten his life. His parents heard of a similar case in Holland where a child was being treated successfully with cannabis-based medicines, which were licensed there.
Child A has now been receiving cannabis treatment in The Hague with enormous success. His doctor here is convinced of the safety and efficacy of these medicines, which are not licensed here, but is frightened to treat him with them because he is afraid that the GMC will strike him off. The family can no longer afford to remain in The Hague, yet the Home Office tells me that it will not grant a special licence for the treatment in the UK. This child could die of his fits. His parents would agree in a heartbeat for him to receive the medicines here, even though they are unlicensed. They know the risk is small and the benefits huge. They  should have the right to make that decision for their child, just as the cancer patients mentioned by the noble Baroness should have the right to make decisions about risks and about their own treatment. What is the Minister going to do about that?

Baroness Thornton: My Lords, at the beginning of this debate it became clear that we are dealing with one of those extraordinary parliamentary moments. In a way, I have a much easier job than the Minister today, so my sympathy is with him in answering this debate.
Are any of us surprised that when Tessa, my noble friend Lady Jowell, was diagnosed with what she called this “bloody tumour”, she tried with her usual courage, energy and vigour to try to improve the outcomes for all people with cancer? No, we are not, because this is the woman who, as the first ever Public Health Minister, promoted the tobacco control that we all now take for granted, facing outrage from the tobacco industry, its friends at the Sun and the Mail and, though probably less well-known to the public, many Back-Bench Labour MPs who thought pubs and clubs would go out of business if people were not allowed to drink in the smog created by cigarettes. “Nanny” was the label that the papers gave her at the time, but how many lives have been saved already as a result of my noble friend’s determination to do the right thing? The label of nanny was continued because of Sure Start—of course it was. But this is a woman whose determination led her to take on the Prime Minister and all comers to convince us that the Olympics should come to London, could come to London and, when they did so, to ensure, with others, that we all had an absolutely great time in 2012.
The reason I am reminding the House of these matters is not only because of my admiration for my friend Tessa. I am reminding the House, particularly the Minister, that in the face of opposition and scepticism, my noble friend will win through. She has proved to be correct time and again. I say to the Minister and the Government that they had better believe this noble Baroness and take what she is telling us very seriously. From the relatively modest suggestion that fluorescent dye to identify the tumour should be available in all brain surgery centres in England, which seems to me perfectly correct, to the more innovative—adaptive clinical trials, testing multiple treatments against a standard, which could speed up the introduction of new drugs as well as enabling existing ones to be repurposed, linked to a platform to share data across the world—my noble friend is saying: this is a demanding new paradigm, but the prize is surely worth the struggle.
The Government and all of us should follow her example and not be afraid to commit to making this happen.

Lord O'Shaughnessy: My Lords, I begin by joining all Members of this House in paying fulsome tribute to the noble Baroness,  not just for securing this debate today but for the extraordinary character she is showing by leading it. It has been a rich and moving discussion and, as the noble Lord, Lord Blunkett, said, it is extremely daunting to follow her and try to do justice to the requests and speech she has made, but it is also a privilege to be able to do that on behalf of the Government.
I also praise the noble Baroness for the determination that she has shown in raising the profile of issues around cancer treatment during the course of her illness. I think it is fair to say that she has inspired us all, and many cancer sufferers too, but I suppose we should expect nothing less from the woman who brought us the most wonderful Olympic and Paralympic Games in 2012.
I am also very grateful to the noble Baroness for sharing her speech, via the noble Baroness, Lady Thornton, and I have done everything I can to address in my response today the questions that she has asked. She will forgive me if there are any stones left unturned; perhaps we can pick them up afterwards.
As we have heard, every story about cancer is a personal one, but behind those stories lie some very stark numbers. As our population ages, the prevalence of cancer rises. One in two of us will get cancer at some stage in our life. The question is not so much how we stop that happening, but how we can diagnose and treat it more quickly and effectively, so that it moves from being a life-threatening disease to one that can be managed throughout a normal and happy lifetime.
We must be honest in saying we are not yet there. Historically, we have lagged behind the best performing countries in Europe, and catching up with those standards has been a focus for successive Governments, including this one.
There is good news. Things are getting better. In the past eight years, various actions, including the establishment of the cancer drugs fund, mean that there are about 7,000 people alive who would not have been otherwise, but, as we have heard, the benefits of these actions are spread unevenly. Survival rates for certain cancers are stubbornly low. Testicular cancer has been transformed into a nearly totally curable disease, but for other cancers—we have heard about oesophageal, stomach, pancreatic, lung, liver and, unfortunately, brain cancers—very little progress has been made. There is much still to do and we need to do better.
The first step towards achieving the world-class cancer outcomes we all want and which NHS patients rightly expect is to have a plan backed by the cancer community. As noble Lords will know, that plan was provided three years ago by the Independent Cancer Taskforce, which provided a cancer strategy aimed at saving 30,000 lives a year by 2020. It was truly a landmark moment. As any Government would have, the Government accepted the recommendations of the strategy and have backed it with funding.
It starts, of course, with prevention, and we have heard about the vigour with which the noble Baroness pursued public health and prevention when she was a Health Minister. Smoking and obesity remain the  biggest preventable risk factors for cancer. That is why last year the Government introduced a childhood obesity strategy and a tobacco control plan for England. The truth is that we are making progress on smoking, and rates are coming down for almost every age group. However, we have a long way to go to tackle the obesity epidemic which we have not yet done. More courage is needed, I fear.
As the noble Baroness also said, early diagnosis is critical, and there are new early diagnosis standards, including a new 28-day faster-diagnosis standard. However, we all know that it is not just about targets but about bringing the best diagnostic tools and therapies into the NHS more quickly. There are also incredibly exciting discoveries in diagnostic science happening as we speak. I am sure that noble Lords will have heard about the successful trial of a blood test for cancers by a team at Johns Hopkins University, and we want our NHS to be able to bring on these kinds of innovations as quickly as possible. I am hopeful that our new accelerated access pathway, whose team meets for the first time next week and which becomes operative in April, will be looking at these kinds of technologies and will provide opportunities for them to come into the health service for NHS patients up to four years quicker than is currently the case.
At the centre of every cancer experience is a human being, their family and friends, with all the emotional and physical needs that attend. So it is right to expect that every patient is treated with compassion and dignity. The National Cancer Patient Experience Survey shows that more cancer patients are experiencing positive care overall, which is extremely welcome. I want to use this opportunity to pay tribute not only to the amazing NHS and care staff who deliver that care for cancer patients, but to our extraordinary range of charities and voluntary organisations. It is invidious to name some, but Macmillan Cancer Support, Cancer Research UK, The Brain Tumour Charity, and others provide outstanding support to people with, and recovering from, cancer.
Of course, their illness is not what defines cancer patients; life goes on, with its usual joys—if I heard the radio correctly, I think that for the noble Baroness that includes dancing—as well as its challenges. Making sure that life can go on as normal, or as close to normal as possible, is essential. At the moment, standards of care are high but there is local variation, and that is why there is a plan to create a national recovery package that is there for every cancer patient from the moment they are diagnosed. Inevitably, where the Government can make the most difference is in providing the necessary investment. I would like to highlight three examples of that investment, and shall attempt to avoid the list that Ministers often slip in to these kind of speeches. There are two areas where investment is really making an impact for cancer patients.
Elsewhere, the noble Baroness, Lady Jowell, has spoken about the surgery required to treat her cancer, which can be highly invasive and debilitating. There is major investment, I am pleased to say, in the modernisation of radiotherapy equipment taking place across England, including two new proton beam therapy centres. Combined with new approaches to surgery,  it is hoped that that will bring benefits to around 6,000 brain tumour patients a year who will get access to less invasive surgeries. The noble Baroness specifically asked about the availability of a key florescent dye, and I can tell her it is called 5-ALA. It helps surgeons to see malignant tissue, so helps to ensure a more accurate surgical margin during surgery. We have spoken to NHS England in advance of this debate, which has committed to working with the cancer alliances and the brain cancer surgery centres to drive national uptake of its usage.
I also want to highlight another innovation or change, which is a big investment in the health infrastructure through 20 biomedical research centres in England. I had the opportunity to visit one of these last year at University College London Hospital, where I met some wonderful and very brave cancer patients who were among some of the very first people in the world to trial immuno and combined therapies, and they absolutely understand the importance of giving patients a choice about the ability to take risks when the prize is extra months of life with the people they love. These centres and their clinical research networks are now recruiting or have set up around 700 trials. I am just sorry that the noble Baroness was unable to find one in this country that she could access for her particular form of cancer. I can promise her that our determination, like hers, is that British cancer patients should not have to travel abroad to be part of trials or to access the kind of treatments that they need for their cancer.
Before closing, I want to address a number of the other issues raised by the noble Baroness during her speech. I absolutely agree with her that more investment is needed in cancer research for brain cancer. Making that happen is a specific objective of the departmental working group that has been operating under our Chief Scientific Adviser, Professor Chris Whitty. I can confirm that this group will deliver its final report to me next Wednesday, and I can also say today that one action stemming from that will be a highlight notice from the National Institute for Health Research to encourage researchers to submit applications for funding in the specific area of brain cancer research. I hope that some of the interesting ideas and research projects going on today will look at that opportunity so that we get more funding into this important area.
The noble Baroness also talked about the importance of adaptive trials. I am again pleased to report that they form a growing proportion of the clinical research network’s portfolio and are mainly in cancer trials. We undoubtedly need to be more radical in this, and the noble Baroness has provided a specific suggestion. I would be delighted to meet the director of the ECI, and I am thrilled that he is here today to hear the debate.
There has been, as the noble Baroness pointed out, a lack of new brain cancer drugs. Again, we have been in touch with the National Institute for Health and Care Excellence—I did not know that she had a role in its founding—about this. I am informed that there are a number of drugs in development specifically for glioblastoma and NICE has committed to publishing draft guidance on these drugs before they receive a  licence. Drugs recommended in the draft guidance will be funded from the point of licensing, which brings forward the opportunity to use them by many months.
The noble Baroness also talked about the importance of data and having access to data. I could not agree more. As we know, one of the wonderful things about the NHS is that it is here for all of us, all the time. One quirk of the way that it was set up—I am not sure that Nye Bevan intended it, but it is certainly a benefit—is that it has an unrivalled dataset on patients’ medical experiences and journeys, which is invaluable to the research community. We all know that we have not always got policy right in this area or brought the public with us about the benefits of sharing data, but there are some key decisions coming up in the next few months to help us to access and create that dataset for research purposes. I warmly welcome the opportunity to engage with the noble Baroness and other noble Lords to make sure that we can win the argument with the public about sharing data for the benefit of not just ourselves but one another.
There have been many questions from noble Lords, and I hope that they will forgive me for not trying to answer all of them in the interests of time. I will of course write to any noble Lords whom I have not answered specifically. I just want to highlight three other things. First, genomic medicine and its potential in combination with artificial intelligence and machine learning have been mentioned. We have a set of 5,000 whole cancer genome sequences—believe it or not, that is the biggest set in the world. But, thinking about the number of people getting cancer every year, we need to do much better on this. There are big ambitions here, and I hope to use the opportunity of the NHS’s 70th birthday to make real progress in something ambitious in this area.
Several noble Lords asked about the Lords’ sustainability report. The department is perhaps not shown in its best light in how late the response has been. It will be published very soon, I can promise that. The issue of taxation has also been raised. I hope that noble Lords will forgive me if I say that is above my pay grade. They may also have noticed, however, that the Secretary of State for Health and Social Care has been here throughout the whole debate and listening intently. So I am looking to him, as I know that he will be making a case across government.
Finally, I have been a Minister for long enough to know that you cannot have a debate without talking about Brexit—so let us make it quick and positive. Clinical trials have been mentioned, but we should also mention medicine regulation. The Government’s intention, going into that negotiation, is to have a new way to create the same kind of partnership that we have now, not just for the good of patients in this country but for those across the EU as well. That is our intention and we think that is the right thing to do.
To close, I would like to talk about a word on which the noble Baroness focused towards the end of her speech, and that word is “Hope”—it also happens to be the name of my youngest daughter. The NHS symbolises many noble ideas—reassurance, compassion and service to others—but more than anything it provides people with hope: hope of a better life and  more years enjoyed, not just for themselves but for those they hold dear: hope for a better today and for a better tomorrow.
What the noble Baroness has done today is to offer hope. With her courage in calling and leading this debate, and with her ever-fertile mind making suggestions for how we can improve cancer care, she raises our sights and demands that, collectively, we work harder to offer hope to people affected by the terrible disease she suffers with such dignity. It is the right challenge, and one I am prepared to accept on behalf of the Government. In doing so, I promise her that our efforts will not waver until the scourge of cancer no longer robs us of the ones we love.

Baroness Jowell: I thank the Minister very much indeed for a really inspiring and excellent summary of  our discussion. Obviously, I would like to thank everybody else who has considered, and taken part in, the discussion today. I feel that we have made real progress forward. It happens very rarely in this sort of way and I am absolutely delighted and grateful to everybody for their contributions and for the support that the Minister will continue to have. I thank my very dear, long-standing friend, the Secretary of State. He will keep his own—I always have a problem talking about this but he will know exactly what I am talking about. Everything will be done as we hope it will, so thank you very much indeed. Now we look forward to the progress.
[Applause.]

Baroness Chisholm of Owlpen: My Lords, on a momentous day, I beg to move that we adjourn the House.
House adjourned at 6.12 pm.